Kallwitz Eric R, Herdegen James, Madura James, Jakate Shriram, Cotler Scott J
Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
J Clin Gastroenterol. 2007 Nov-Dec;41(10):918-21. doi: 10.1097/01.mcg.0000225692.62121.55.
Recent studies have shown an association between obstructive sleep apnea (OSA) and elevated liver enzymes in patients with nonalcoholic fatty liver disease (NAFLD). The aim of the current study was to compare biochemical and histologic findings in patients with NAFLD as a function of OSA status.
Subjects consisted of 85 patients who had a sleep study followed by a liver biopsy performed at the time of obesity surgery. The diagnosis of OSA was based on an apnea hypopnea index of >/=15. Demographic and laboratory data were collected retrospectively. Liver biopsies were systematically evaluated for features of NAFLD including degree of steatosis, inflammation, and fibrosis.
All but one patient had histologic evidence of NAFLD and 51% of the study population had OSA. A higher proportion of patients with OSA had elevated alanine aminotransferase levels (13/39) compared with those without OSA (3/34) (P=0.01). Only 19% of subjects had fibrosis on liver biopsy and still fewer (5%) had bridging fibrosis or cirrhosis. There was a trend toward a higher prevalence of OSA in patients with evidence of progressive liver disease, as indicated by inflammation plus fibrosis (11/15), compared with those with inflammation alone (22/48) (P=0.06).
In obese patients with NAFLD, OSA was associated with elevated alanine aminotransferase levels and a trend toward histologic evidence of progressive liver disease.
近期研究表明,非酒精性脂肪性肝病(NAFLD)患者中,阻塞性睡眠呼吸暂停(OSA)与肝酶升高之间存在关联。本研究旨在比较NAFLD患者根据OSA状态的生化和组织学结果。
研究对象包括85例患者,这些患者在肥胖手术时进行了睡眠研究并随后进行了肝活检。OSA的诊断基于呼吸暂停低通气指数≥15。回顾性收集人口统计学和实验室数据。对肝活检标本进行系统评估,以确定NAFLD的特征,包括脂肪变性程度、炎症和纤维化。
除1例患者外,所有患者均有NAFLD的组织学证据,51%的研究人群患有OSA。与无OSA的患者(3/34)相比,OSA患者中丙氨酸氨基转移酶水平升高的比例更高(13/39)(P = 0.01)。肝活检中仅有19%的受试者有纤维化,更少(5%)有桥接纤维化或肝硬化。与仅有炎症的患者(22/48)相比,炎症加纤维化提示有进行性肝病证据的患者中OSA患病率有升高趋势(11/15)(P = 0.06)。
在患有NAFLD的肥胖患者中,OSA与丙氨酸氨基转移酶水平升高以及有进行性肝病组织学证据的趋势相关。