Clinical and Molecular Hepatology (대한간학회지)

The Korean Association for the Study of the Liver (대한간학회)
권호 표지

Nonalcoholic fatty liver disease as a risk factor of cardiovascular disease; Relation of non-alcoholic fatty liver disease to carotid atherosclerosis

심혈관계 위험인자로서의 비알코올지방간질환; 경동맥 동맥경화와의 상관관계

Choi, Su-Yeon;Kim, Dong-Hee;Kang, Jin-Hwa;Park, Min-Jung;Kim, Young-Sun;Lim, Seon-Hee;Kim, Chung-Hyeon;Lee, Hyo-Suk
최수연;김동희;강진화;박민정;김영선;임선희;김충현;이효석

  • Published : 20080000
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Abstract

Background/Aims: Non-alcoholic fatty liver disease (NAFLD) is closely associated with abdominal obesity, dyslipidemia, hypertension, and Type 2 diabetes, which are all features of the metabolic syndrome. The aim of the present study was to elucidate whether NAFLD is associated with carotid atherosclerosis. Methods: The study population comprised 659 subjects without hepatitis B and C infections and who did not consume alcohol. Fatty infiltrations of liver were detected by abdominal ultrasonography, and intima-media thickness (IMT) and plaque prevalence were estimated by carotid ultrasonography. Results: The mean values of systolic and diastolic pressures, body mass index (BMI), aspartate aminotransferase, alanine aminotransferase, gamma- glutamyl transpeptidase, uric acid, total cholesterol, triglycerides, high density lipoprotein (HDL) cholesterol, fasting glucose, fasting insulin, homeostasis model of assessment (HOMA) index, hemoglobin A1c, and plasminogen activator inhibitor-1 differed significantly between patients with NAFLD (n=314) and normal controls (n=345). The carotid IMT was 0.817±0.212 (mean±SD) mm in patients with NAFLD and 0.757±0.198 mm in normal controls (p<0.001). The prevalence of carotid plaques was higher in patients with NAFLD (26.4%) than in normal controls (15.9%) (p<0.001). This association persisted significantly after adjusting for age, sex, BMI, HOMA index and individual factors of metabolic syndrome by multiple logistic regression analysis. Conclusions: Patients with NAFLD are at a high risk of carotid atherosclerosis regardless of metabolic syndrome and classical cardiovascular risk factors. Therefore, the detection of NAFLD should alert to the existence of an increased cardiovascular risk. Moreover, NAFLD might be an independent risk factor for cardiovascular disease. (Korean J Hepatol 2008;14:77-88)

목적 : 비 알코올지 방간질환(Non-alcoholic fatty liver disease, NAFLD)은 비만, 고지혈증, 언슐린저항성, 제2형 당뇨병 등과 밀접히 연관되어 있고, 이는 NAFLD가 대사증후군의 하나의 간내 발현일수 있음을 시사한다. 이와 같은 NAFLD와 대사증후군의 상호연관성에 대한 관섬이 증가되어 가면서 대사증후군이 심혈관계 질환의 위험성을 증가시키듯 NAFLD의 존재가 섬혈관계 질환의 위험인 자가 된다는 다수의 연구 결과들이 있다. 본 연구는 잠재적인 동맥경화를 진단하는 비침습적인 검사인 경동맥초음파검사를 통한 경동맥 내중막 두께와 경동맥 플라크의 유무를 NAFLD군과 정상군 사이에 비교 분석하여 NAFLD가 섬혈관계 질환의 위험인자인지를 알아보고자 하였다. 대상과 방법: 2005년 1월부터 ``2fff1년 8월까지 서울대학교병원 강남센터에서 복부초음파와 경동맥초음파검사를 시행하고 연구에 동의한 823명 중 알코올 음주력과 심혈관계 질환의 과거력이 없고 혈청검사로 B형, C형간염 이 없는 659명을 대상으로 하였다. NAFLD군과 정상군의 체질량지수, 허리둘레, 혈압, 간기능 검사와 지질검사, 인슐린, 기타 심혈관계 위험인자를 측정하였고, 양 군 간에 경동맥초음파검사를 통해 구한 내중막 두께와 경동맥 플라크 유무를 비교하였다. 결과: NAFLD군은 314명(47.6%)이고 정상군은 345명이었다. 양 군 간에 유의한 차이를 보인 인구학적, 생화학적 인자들로는 수축기혈압, 이완기 혈압, 체질량지수, 허리둘레, AST, ALT, γ-GT, 요산, 총 콜레스테롤, 중성지방, 고밀도지질단백 콜레스테롤, 공복혈당, 공복인슐린,HOMA지수, 당화혈색소, PAI-1이었다. 양군간에 경동맥 내중막 두께의 평균을 비교하면 NAFLD군이 0.817±0.212 mIll이고 대조군이 0.757±0.198 mm로 통계 적으로 유의한 차이를 보였다(p

Keywords

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