慢性心力衰竭失代偿期住院患者非酒精性脂肪肝的患病率和预后价值

IF 0.5 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Kardiologiya Pub Date : 2023-12-27 DOI:10.18087/cardio.2023.12.n2360

I A Misan, O S Arisheva, I V Garmash, F R Cabello, Zh D Kobalava

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引用次数: 0

摘要

目的研究慢性心力衰竭失代偿期（DCHF）患者非酒精性脂肪肝（NAFLD）的发生率及其对临床预后的影响。男性占51.2%，平均年龄（72.8±11.7）岁），动脉高血压（AH）占90%，心肌梗死占37%，心房颤动占64%，慢性肾脏病（CKD）占42%，2型糖尿病（T2DM）占35%，左室射血分数（LVEF）为40%的占27%。非酒精性脂肪肝的诊断依据是俄罗斯治疗师科学医学会和俄罗斯胃肠病学家科学学会的《2021 年临床指南》。肝脏脂肪变性的阶段是通过瞬态弹性测量法确定的，并使用 FibroScan 设备评估超声波的受控衰减参数 (CAP)（S，dB/m）。阈值 CAP 值 <294 dB/m 与脂肪变性程度相对应：结果 28.9% 的患者确诊为非酒精性脂肪肝。患者分为两组：第一组包括合并非酒精性脂肪肝的 CHF 患者（98 人，占 28.9%，男性占 50.0%）；第二组包括合并非酒精性脂肪肝的 CHF 患者（240 人，占 71.0%，男性占 51.6%）。多变量回归分析显示，非酒精性脂肪肝的独立预测因素是收缩压≥130 mm Hg（比值比（OR），3.700；p <0.001）、T2DM病史（OR，2.807；p <0.005）和腰围>111 cm（OR，2.530；p <0.012）。CAP≥331 dB/m（S3）的患者在2年随访期间的综合不良预后（全因死亡+再入院）较差（Kaplan-Meier曲线 - Log-Rank p=0.035）。AH、T2DM和腹部肥胖与非酒精性脂肪肝的高风险相关。然而，在对已知风险因素进行调整后，只有严重脂肪变性（S3）是两年内不良临床结果的独立预测因素。

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Prevalence and Prognostic Value of Non-Alcoholic Fatty Liver Disease in Patients Hospitalized With Decompensated Chronic Heart Failure.

Aim To study the incidence and effect of non-alcoholic fatty liver disease (NAFLD) on clinical outcomes in patients with decompensated chronic heart failure (DCHF).Material and methods The study included 338 patients with NYHA functional class III-IV DCHF (51.2% men, mean age 72.8±11.7 years), arterial hypertension (AH) in 90%, myocardial infarction in 37%, atrial fibrillation in 64%, chronic kidney disease (CKD) in 42%, type 2 diabetes mellitus (T2DM) in 35%, left ventricular ejection fraction (LVEF) <40% in 27%. NAFLD was diagnosed based on the 2021 Clinical Guidelines of the Russian Scientific Medical Society of Therapists and the Scientific Society of Gastroenterologists of Russia. The stage of liver steatosis was determined using transient elastometry with assessment of the controlled attenuation parameter (CAP) of ultrasound (S, dB/m) using a FibroScan device. Threshold CAP values <294 dB/m corresponded to the degree of steatosis: S0; S1, 295-309 dB/m; S2, 310-330 dB/m; S3, ≥331 dB/m.Results NAFLD was diagnosed in 28.9% of patients. The patients were divided into two groups: group 1 included patients with CHF and NAFLD (n=98 (28.9%), 50.0% men) and group 2 included patients with CHF without NAFLD (n=240 (71.0 %), 51.6% men). A multivariate regression analysis showed that independent predictors of NAFLD were systolic blood pressure ≥130 mm Hg (odds ratio (OR), 3.700; p <0.001), history of T2DM (OR, 2.807; p <0.005), and waist circumference >111 cm (OR, 2.530; p <0.012). Patients with CAP ≥331 dB/m (S3) had a worse prognosis during the 2-year follow-up for the composite adverse outcome (all-cause mortality + readmission) (Kaplan-Meier curves - Log-Rank p=0.035).Conclusions NAFLD was detected in almost one-third of patients hospitalized for DCHF. AH, T2DM, and abdominal obesity were associated with a high risk of NAFLD. However, only severe steatosis (S3) was an independent predictor of adverse clinical outcomes during a 2-year period after adjustment for known risk factors.

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来源期刊

Kardiologiya 医学-心血管系统

CiteScore

1.70

自引率

20.00%

发文量

审稿时长

3-8 weeks

期刊介绍： “Kardiologiya” (Cardiology) is a monthly scientific, peer-reviewed journal committed to both basic cardiovascular medicine and practical aspects of cardiology. As the leader in its field, “Kardiologiya” provides original coverage of recent progress in cardiovascular medicine. We publish state-of-the-art articles integrating clinical and research activities in the fields of basic cardiovascular science and clinical cardiology, with a focus on emerging issues in cardiovascular disease. Our target audience spans a diversity of health care professionals and medical researchers working in cardiovascular medicine and related fields. The principal language of the Journal is Russian, an additional language – English (title, authors’ information, abstract, keywords). “Kardiologiya” is a peer-reviewed scientific journal. All articles are reviewed by scientists, who gained high international prestige in cardiovascular science and clinical cardiology. The Journal is currently cited and indexed in major Abstracting & Indexing databases: Web of Science, Medline and Scopus. The Journal''s primary objectives Contribute to raising the professional level of medical researchers, physicians and academic teachers. Present the results of current research and clinical observations, explore the effectiveness of drug and non-drug treatments of heart disease, inform about new diagnostic techniques; discuss current trends and new advancements in clinical cardiology, contribute to continuing medical education, inform readers about results of Russian and international scientific forums; Further improve the general quality of reviewing and editing of manuscripts submitted for publication; Provide the widest possible dissemination of the published articles, among the global scientific community; Extend distribution and indexing of scientific publications in major Abstracting & Indexing databases.