关键词：冠状动脉斑块,非酒精性脂肪肝,关联

2014年11月6日 讯 /生物谷BIOON/ --近日，来自哈佛大学医学院等处的研究人员利用冠状动脉成像技术（CCTA）揭示了高风险冠状动脉斑和常见肝病之间的紧密关联，相关研究刊登于国际杂志Radiology上。

此前研究显示CCTA可以检测出高风险冠状动脉斑或者易于危及生命的斑块；本文研究中研究者调查了高风险斑块和非酒精性脂肪性肝病（NAFLD）之间的关系，NAFLD的主要特点为肝功能异常，但并非和过度酒精摄入有关；NAFLD是最常见的一种肝病，据估计一般人群中患该疾病的个体占到了20%至30%。

目前研究者很清楚动脉粥样硬化和炎症之间的关系，下一步就是揭示高风险的斑块和其它系统性的炎症比如NAFLD之间的关联。文章中研究人员对来自急诊科进行急性胸痛CCTA扫描的个体进行研究，这些患者会进行非强化的CT扫描来评估其冠状动脉钙量，冠状动脉钙量是动脉粥样硬化的标志物，同时对这些患者进行强化CCTA扫描来进行对比，医生在线答疑，研究人员就可以通过CCTA成像来对患者机体的高风险斑块进行评估。

在445名病人中，有182名患者（40.9%）有通过CT确定NAFLD的证据，在NAFLD患者中仅在59.3%的个体机体中发现了高风险斑块，而在非NAFLD的患者中仅有19%的个体存在高风险的斑块；当调整冠状动脉粥样硬化的程度、严重性及传统危险因素后，研究者发现NAFLD和高风险斑块表现出了持久性的关系。

高风险斑块和NAFLD军事系统性代谢障碍的主要症状表现，，目前在临床上的意义包括利用非心脏CT扫描对比来全面评估NAFLD的进展。未来额外评估NAFLD和CT之间的关系或许可以帮助改善冠状动脉疾病患者的成层风险，当然这也正如本文研究的结果一样，揭示了NAFLD的存在和高风险冠状斑块之间的关联，而这种关系的存在是一种独立的传统风险因素。

后期研究人员希望通过更为深入的研究来解释为何NAFLD疾病在高风险冠状动脉粥样硬化病人中如此流行，目前一种理论认为所有的疾病症状都是系统性炎症引发的结果，而影响多种器官的炎性状态最终会危及个体的生命。（生物谷Bioon.com）

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原始参考文献：High-Risk Coronary Plaque at Coronary CT Angiography Is Associated with Nonalcoholic Fatty Liver Disease, Independent of Coronary Plaque and Stenosis Burden: Results from the ROMICAT II Trial

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Previous research has shown that CCTA can detect high-risk coronary artery plaque, or plaque prone to life-threatening ruptures. For the new study, researchers looked at associations between high-risk plaque and non-alcoholic fatty liver disease (NAFLD), a condition characterized by abnormal liver function that is not associated with excessive alcohol consumption. NAFLD is the most common liver disease, with an estimated prevalence of 20 percent to 30 percent in the general population.

"As it is known that atherosclerosis is linked to inflammation, our next step was to look for an association of high-risk plaques with other systemic inflammatory conditions such as NAFLD," said the study's lead author, Stefan B. Puchner, M.D., from Massachusetts General Hospital and Harvard Medical School in Boston and the Medical University of Vienna, Austria. "Interestingly, both pathologies can be detected in a single CT examination."

The researchers drew patients from a large trial focusing on the use of CCTA in people who had come to the emergency department with acute chest pain. The patients underwent both non-enhanced CT to assess coronary calcium, a marker of atherosclerosis, and contrast-enhanced CCTA. Readers assessed the CCTA images for signs of high-risk plaque.

Overall, 182 of the 445 patients in the study, or 40.9 percent, had CT evidence of NAFLD. High-risk plaque was seen in 59.3 percent of patients with NAFLD, compared to only 19 percent of those without NAFLD. The association between NAFLD and high-risk plaque persisted after adjusting for the extent and severity of coronary atherosclerosis and traditional risk factors......

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