[Metabolic associated fatty liver disease and myocardial ischemia in non-obese patients suspected of coronary artery disease].

摘要

Objective: To explore the association between metabolic dysfunction-associated fatty liver disease (MAFLD) and myocardial ischemia in non-obese patients with suspected coronary heart disease (CAD), and to analyze the differences in this association across subgroups stratified by body mass index (BMI) and coronary artery lesion severity. Methods: This retrospective study enrolled non-obese patients (18.5 kg/m²≤BMI<28.0 kg/m²) with suspected CAD who underwent stress/rest radionuclide myocardial perfusion imaging (MPI) at the Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University between January 1, 2022 and December 31, 2024. Patients were divided into myocardial ischemia group and non-ischemia group based on MPI findings. MAFLD diagnosis was determined based on hepatic steatosis detected by low-dose CT integrated with single-photon emission computed tomography/CT (SPECT/CT), combined with established diagnostic criteria (no excessive alcohol consumption plus presence of metabolic dysfunction). Univariate and multivariate logistic regression models were applied to analyze the correlation between MAFLD and myocardial ischemia. Stratified analyses were further performed according to BMI (normal weight: 18.5 kg/m²≤BMI<24.0 kg/m²; overweight: 24.0 kg/m²≤BMI<28.0 kg/m²) and coronary angiography results (obstructive or non-obstructive CAD) to assess the relationship between MAFLD and myocardial ischemia in each subgroup. Results: A total of 271 patients with suspected CAD were enrolled, aged (61.6±10.2) years, with 143 (52.8%) males. There were 135 patients in the myocardial ischemia group and 136 in the non-ischemia group. MAFLD was diagnosed in 88 patients (32.5%). The proportion of patients diagnosed with MAFLD was higher in the myocardial ischemia group than in the non-myocardial ischemia group (61 cases (45.2%) vs. 27 cases (19.9%), P<0.001). Multivariate logistic regression analysis showed that MAFLD was independently associated with myocardial ischemia (OR=3.43, 95%CI 1.85-6.28, P<0.001). Subgroup analysis revealed that MAFLD was associated with myocardial ischemia in both normal weight group (OR=7.62, 95%CI 2.48-23.44, P<0.001) and overweight group (OR=2.60, 95%CI 1.20-5.60, P=0.015), with a stronger association observed in normal-weight individuals. This association also existed in non-obstructive CAD group (OR=6.50, 95%CI 2.23-18.94, P<0.001) and obstructive CAD group (OR=3.05, 95%CI 1.37-6.80, P=0.006). Conclusion: MAFLD acts as an independent risk factor for myocardial ischemia in non-obese patients with suspected CAD, and this association persists across subgroups stratified by BMI (normal weight vs. overweight) and coronary lesion phenotype (obstructive vs. non-obstructive CAD). 目的： 探讨非肥胖疑似冠心病患者代谢相关脂肪性肝病（MAFLD）与心肌缺血的关联，并分析该关联在不同体重指数（BMI）、不同冠状动脉阻塞状态亚组中的差异。 方法： 回顾性纳入2022年1月1日至2024年12月31日于苏州大学附属第三医院核医学科行负荷/静息核素心肌灌注显像的非肥胖（18.5 kg/m²≤BMI<28.0 kg/m²）疑似冠心病患者。根据心肌灌注显像检查结果将患者分为心肌缺血组与无心肌缺血组。基于单光子发射计算机断层显像/CT同机低剂量CT肝脏脂肪沉积表现，并结合相关诊断标准（无过量饮酒史、合并代谢功能障碍）判定MAFLD患病情况。采用单因素及多因素logistic回归模型分析MAFLD与心肌缺血的相关性。进一步按BMI水平（体重正常：18.5 kg/m²≤BMI<24.0 kg/m²，超重：24.0 kg/m²≤BMI<28.0 kg/m²）及冠状动脉造影结果（阻塞性或非阻塞性冠状动脉疾病）开展分层分析，探讨各亚组中MAFLD与心肌缺血的关联。 结果： 共纳入271例疑似冠心病患者，年龄（61.6±10.2）岁，男性143例（52.8%）。心肌缺血组135例，无心肌缺血组136例。88例（32.5%）患者诊断为MAFLD。心肌缺血组的MAFLD患者比例高于无心肌缺血组［61例（45.2%）比27例（19.9%），P<0.001］。多因素logistic回归分析结果显示，MAFLD与心肌缺血独立相关（OR=3.43，95%CI 1.85~6.28，P<0.001）。亚组分析结果显示，正常体重组（OR=7.62，95%CI 2.48~23.44，P<0.001）与超重组（OR=2.60，95%CI 1.20~5.60，P=0.015）中，MAFLD均与心肌缺血相关，体重正常组关联程度更高；非阻塞性冠状动脉疾病组（OR=6.50，95%CI 2.23~18.94，P<0.001）与阻塞性冠状动脉疾病组（OR=3.05，95%CI 1.37~6.80，P=0.006）中同样存在上述关联。 结论： 非肥胖疑似冠心病患者中MAFLD是心肌缺血的独立相关因素，该关联在正常体重与超重亚组、阻塞性与非阻塞性冠状动脉疾病亚组中均存在。.