非酒精性脂肪性肝病与冠心病患者冠脉狭窄程度的相关性分析

doi:10.11958/20260303

摘要/Abstract

摘要：

目的探讨非酒精性脂肪性肝病（NAFLD）对冠心病（CHD）患者冠脉狭窄程度的影响，并分析前蛋白转化酶枯草溶菌素9（PCSK9）及炎性因子在其中的作用。方法选取2015年9月—2025年9月于天津市南开医院经冠状动脉造影确诊的CHD住院患者537例，依据腹部B超或CT结果分为非NAFLD组、轻度NAFLD组和中重度NAFLD组。检测血清生化指标及PCSK9、白细胞介素（IL）-1β、IL-6、肿瘤坏死因子-α（TNF-α）水平；采用Gensini评分评估冠脉狭窄程度。分析NAFLD与冠脉狭窄程度及各指标的相关性。结果非NAFLD组、轻度NAFLD组和中重度NAFLD组Gensini评分依次升高（P<0.05）；非NAFLD组、轻度NAFLD组、中重度NAFLD组总蛋白（TP）、血清丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、谷氨酰基转移酶（GGT）、乳酸脱氢酶（LDH）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、PCSK9、IL-1β、IL-6、TNF-α水平依次升高，白蛋白（ALB）、高密度脂蛋白胆固醇（HDL-C）水平依次降低（均P<0.05）。Spearman相关分析显示，NAFLD严重程度与TP、ALT、AST、GGT、LDH、TC、TG、LDL-C、PCSK9、IL-1β、IL-6、TNF-α水平及Gensini评分均呈正相关，与ALB、HDL-C水平呈负相关（均P<0.05）。Pearson相关分析显示，Gensini评分与TP、ALT、AST、GGT、LDH、TC、TG、LDL-C、PCSK9、IL-1β、IL-6、TNF-α水平均呈正相关，与ALB呈负相关（均P<0.05）；PCSK9与IL-1β、IL-6、TNF-α水平亦呈正相关（均P<0.05）。结论 NAFLD与CHD患者冠脉狭窄程度呈正相关，其机制可能与PCSK9水平升高、炎症反应及脂质代谢紊乱有关。

关键词: 非酒精性脂肪性肝病, 冠心病, 冠状动脉狭窄, 前蛋白转化酶枯草溶菌素9, 细胞因子类, 脂质代谢障碍

Abstract:

Objective To investigate the effect of non-alcoholic fatty liver disease (NAFLD) on the severity of coronary artery stenosis in patients with coronary heart disease (CHD), and to analyze the role of proprotein convertase subtilisin/kexin type 9 (PCSK9) and inflammatory factors in it. Methods A total of 537 CHD inpatients diagnosed by coronary angiography at Tianjin Nankai Hospital from September 2015 to September 2025 were enrolled. Based on abdominal ultrasound or CT findings, they were divided into the non-NAFLD group, the mild NAFLD group and the moderate-to-severe NAFLD group. Serum biochemical parameters, levels of PCSK9, interleukin-1β (IL-1β), IL-6 and tumor necrosis factor-α (TNF-α) were measured. The Gensini score was used to assess the severity of coronary artery stenosis. The correlations between NAFLD and the severity of coronary stenosis as well as various indicators were analyzed. Results The Gensini scores of the non-NAFLD group, the mild NAFLD group and the moderate-to-severe NAFLD group increased successively (P<0.05). Serum levels of total protein (TP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), lactate dehydrogenase (LDH), creatine kinase (CK), CK-MB, total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), PCSK9, IL-1β, IL-6 and TNF-α increased sequentially in the non-NAFLD group, the mild NAFLD group and the moderate-to-severe NAFLD group, while levels of albumin (ALB) and high-density lipoprotein cholesterol (HDL-C) decreased sequentially (all P<0.05). Spearman correlation analysis revealed that the severity of NAFLD was positively correlated with TP, ALT, AST, GGT, LDH, TC, TG, LDL-C, PCSK9, IL-1β, IL-6, TNF-α levels and Gensini score, and negatively correlated with ALB and HDL-C levels (all P<0.05). Pearson correlation analysis showed that Gensini score was positively correlated with TP, ALT, AST, GGT, LDH, TC, TG, LDL-C, PCSK9, IL-1β, IL-6 and TNF-α levels, and negatively correlated with ALB (all P<0.05). PCSK9 was also positively correlated with IL-1β, IL-6 and TNF-α levels (all P<0.05). Conclusion NAFLD is positively correlated with the severity of coronary artery stenosis in CHD patients, and the underlying mechanism may be related to the elevated PCSK9 levels, inflammatory response and lipid metabolism disorders.

Key words: non-alcoholic fatty liver disease, coronary heart disease, coronary stenosis, proprotein convertase subtilisin/kexin type 9, cytokines, lipid metabolism disorders

中图分类号:

R541.4，R575.5

图/表 3

参考文献 12

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组别	n		年龄/ 岁		性别（男/女）	BMI/ （kg/m²）
非NAFLD组	219		65.63±10.26		117/102	25.2±3.6
轻度NAFLD组	196		64.92±9.36		105/91	25.4±3.8
中重度NAFLD组	122		65.32±9.36		79/43	25.6±3.9
F或χ²			0.220		1.485	0.460
组别		糖尿病		高血压			高脂血症
非NAFLD组		23（10.50）		35（15.98）			18（8.22）
轻度NAFLD组		18（9.18）		29（14.80）			14（7.14）
中重度NAFLD组		13（10.66）		17（13.93）			12（9.84）
F或χ²		0.238		0.274			0.746

组别	n		年龄/ 岁		性别（男/女）	BMI/ （kg/m²）
非NAFLD组	219		65.63±10.26		117/102	25.2±3.6
轻度NAFLD组	196		64.92±9.36		105/91	25.4±3.8
中重度NAFLD组	122		65.32±9.36		79/43	25.6±3.9
F或χ²			0.220		1.485	0.460
组别		糖尿病		高血压			高脂血症
非NAFLD组		23（10.50）		35（15.98）			18（8.22）
轻度NAFLD组		18（9.18）		29（14.80）			14（7.14）
中重度NAFLD组		13（10.66）		17（13.93）			12（9.84）
F或χ²		0.238		0.274			0.746

组别	n			TP/（g/L）			ALB/（g/L）			ALT/（U/L）
非NAFLD组	219			73.61±15.29			45.28±5.76			31.70±6.54
轻度NAFLD组	196			76.30±20.10^a			43.20±5.80^a			87.98±23.64^a
中重度NAFLD组	122			80.50±22.30^ab			40.10±4.90^ab			110.31±31.99^ab
F				6.045^＊			34.872^＊			474.198^＊
组别			AST/（U/L）			GGT/（U/L）			LDH/（U/L）
非NAFLD组			38.95±7.82			12.35±3.41			170.34±36.58
轻度NAFLD组			76.31±11.78^a			57.32±12.69^a			263.94±45.20^a
中重度NAFLD组			97.03±22.47^ab			69.28±17.41^ab			285.61±75.53^ab
F			580.221^＊			892.441^＊			199.336^＊
组别			CK/（U/L）			CK-MB/（U/L）			TC/（mmol/L）
非NAFLD组			257.62±57.91			74.62±15.59			5.34±1.04
轻度NAFLD组			289.97±75.53^a			119.57±25.91^a			6.54±2.61^a
中重度NAFLD组			331.90±81.04^ab			131.39±31.05^ab			7.83±2.10^ab
F			37.426^＊			204.570^＊			43.511^＊
组别		TG/（mmol/L）			HDL-C/（mmol/L）			LDL-C/（mmol/L）
非NAFLD组		1.59±0.84			1.72±0.69			4.37±1.23
轻度NAFLD组		3.72±1.72^a			1.57±0.68^a			5.25±1.74^a
中重度NAFLD组		4.74±0.93^ab			1.39±0.35^ab			6.58±1.03^ab
F		198.739^＊			10.112^＊			49.380^＊

组别	n			TP/（g/L）			ALB/（g/L）			ALT/（U/L）
非NAFLD组	219			73.61±15.29			45.28±5.76			31.70±6.54
轻度NAFLD组	196			76.30±20.10^a			43.20±5.80^a			87.98±23.64^a
中重度NAFLD组	122			80.50±22.30^ab			40.10±4.90^ab			110.31±31.99^ab
F				6.045^＊			34.872^＊			474.198^＊
组别			AST/（U/L）			GGT/（U/L）			LDH/（U/L）
非NAFLD组			38.95±7.82			12.35±3.41			170.34±36.58
轻度NAFLD组			76.31±11.78^a			57.32±12.69^a			263.94±45.20^a
中重度NAFLD组			97.03±22.47^ab			69.28±17.41^ab			285.61±75.53^ab
F			580.221^＊			892.441^＊			199.336^＊
组别			CK/（U/L）			CK-MB/（U/L）			TC/（mmol/L）
非NAFLD组			257.62±57.91			74.62±15.59			5.34±1.04
轻度NAFLD组			289.97±75.53^a			119.57±25.91^a			6.54±2.61^a
中重度NAFLD组			331.90±81.04^ab			131.39±31.05^ab			7.83±2.10^ab
F			37.426^＊			204.570^＊			43.511^＊
组别		TG/（mmol/L）			HDL-C/（mmol/L）			LDL-C/（mmol/L）
非NAFLD组		1.59±0.84			1.72±0.69			4.37±1.23
轻度NAFLD组		3.72±1.72^a			1.57±0.68^a			5.25±1.74^a
中重度NAFLD组		4.74±0.93^ab			1.39±0.35^ab			6.58±1.03^ab
F		198.739^＊			10.112^＊			49.380^＊

组别		n	PCSK9/（μg/L）		IL-1β/（ng/L）
非NAFLD组		219	307.19±35.42		10.45±2.48
轻度NAFLD组		196	318.52±38.67^a		11.58±2.53^a
中重度NAFLD组		122	352.14±47.83^ab		13.31±2.96^ab
F			49.632^＊		42.157^＊
组别	IL-6/（ng/L）			TNF-α/（ng/L）
非NAFLD组	50.78±4.49			5.14±0.40
轻度NAFLD组	58.34±5.12^a			5.38±0.41^a
中重度NAFLD组	70.42±6.28^ab			5.87±0.49^ab
F	410.892^＊			84.507^＊