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成人非酒精性脂肪肝病纤维化分期越高,死亡等临床预后越差
作者:小柯机器人 发布时间:2021/10/23 23:15:14

美国弗吉尼亚联邦大学医学院Arun J. Sanyal团队对成人非酒精性脂肪肝预后进行了一项前瞻性研究。2021年10月20日出版的《新英格兰医学杂志》发表了这项成果。

在非酒精性脂肪性肝病(NAFLD)的组织学范围内,死亡、肝和非肝结局的预后尚不明确。研究组前瞻性地跟踪了一个包括NAFLD全组织学谱的多中心患者群体,并比较基线组织学特征中的死亡发生率和其他结局。

研究组共对1773名NAFLD成人进行了为期4年的中位随访。全因死亡率随着纤维化分期的增加而增加,其中F0-F2期(无、轻度或中度纤维化)每100人-年死亡0.32人,F3期(桥接纤维化)每100人-年死亡0.89人,F4期(肝硬化)每100人-年死亡1.76人。

每100人-年肝相关并发症的发生率随着纤维化分期的增加而增加,其中静脉曲张出血F0-F2期、F3期、F4期分别为每100人-年0.00、0.06、0.70人,腹水分别为0.04、0.52、1.20人,脑病分别为0.02、0.75、2.39人,肝癌分别为0.04、0.34、0.14人。

与F0-F2期纤维化患者相比,F4期纤维化患者也有较高的2型糖尿病发病率,估计肾小球滤过率下降超过40%。心脏事件和非肝癌的发生率在纤维化阶段相似。在校正年龄、性别、种族、糖尿病状况和基线组织学严重程度后,任何肝失代偿事件(静脉曲张出血、腹水或脑病)的发生率与全因死亡风险增加相关。

研究结果表明,在这项涉及NAFLD患者的前瞻性研究中,F3和F4期纤维化与肝相关并发症和死亡风险增加相关。

附:英文原文

Title: Prospective Study of Outcomes in Adults with Nonalcoholic Fatty Liver Disease

Author: Arun J. Sanyal, M.D.,, Mark L. Van Natta, M.H.S.,, Jeanne Clark, M.D., M.P.H.,, Brent A. Neuschwander-Tetri, M.D.,, AnnaMae Diehl, M.D.,, Srinivasan Dasarathy, M.D.,, Rohit Loomba, M.D., M.H.Sc.,, Naga Chalasani, M.D.,, Kris Kowdley, M.D.,, Bilal Hameed, M.D.,, Laura A. Wilson, Sc.M.,, Katherine P. Yates, Sc.M.,, Patricia Belt, B.S.,, Mariana Lazo, M.D., Ph.D.,, David E. Kleiner, M.D., Ph.D.,, Cynthia Behling, M.D., Ph.D.,, and James Tonascia, Ph.D.

Issue&Volume: 2021-10-20

Abstract:

Background

The prognoses with respect to mortality and hepatic and nonhepatic outcomes across the histologic spectrum of nonalcoholic fatty liver disease (NAFLD) are not well defined.

Methods

We prospectively followed a multicenter patient population that included the full histologic spectrum of NAFLD. The incidences of death and other outcomes were compared across baseline histologic characteristics.

Results

A total of 1773 adults with NAFLD were followed for a median of 4 years. All-cause mortality increased with increasing fibrosis stages (0.32 deaths per 100 person-years for stage F0 to F2 [no, mild, or moderate fibrosis], 0.89 deaths per 100 persons-years for stage F3 [bridging fibrosis], and 1.76 deaths per 100 person-years for stage F4 [cirrhosis]). The incidence of liver-related complications per 100 person-years increased with fibrosis stage (F0 to F2 vs. F3 vs. F4) as follows: variceal hemorrhage (0.00 vs. 0.06 vs. 0.70), ascites (0.04 vs. 0.52 vs. 1.20), encephalopathy (0.02 vs. 0.75 vs. 2.39), and hepatocellular cancer (0.04 vs. 0.34 vs. 0.14). As compared with patients with stage F0 to F2 fibrosis, patients with stage F4 fibrosis also had a higher incidence of type 2 diabetes (7.53 vs. 4.45 events per 100 person-years) and a decrease of more than 40% in the estimated glomerular filtration rate (2.98 vs. 0.97 events per 100 person-years). The incidence of cardiac events and nonhepatic cancers were similar across fibrosis stages. After adjustment for age, sex, race, diabetes status, and baseline histologic severity, the incidence of any hepatic decompensation event (variceal hemorrhage, ascites, or encephalopathy) was associated with increased all-cause mortality (adjusted hazard ratio, 6.8; 95% confidence interval, 2.2 to 21.3).

Conclusions

In this prospective study involving patients with NAFLD, fibrosis stages F3 and F4 were associated with increased risks of liver-related complications and death.

DOI: NJ202110213851706

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2029349

 

期刊信息

The New England Journal of Medicine:《新英格兰医学杂志》,创刊于1812年。隶属于美国麻省医学协会,最新IF:70.67
官方网址:http://www.nejm.org/
投稿链接:http://www.nejm.org/page/author-center/home