David Kristin, Kowdley Kris V, Unalp Aynur, Kanwal Fasiha, Brunt Elizabeth M, Schwimmer Jeffrey B
Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego, La Jolla, CA 92103, USA.
Hepatology. 2009 Jun;49(6):1904-12. doi: 10.1002/hep.22868.
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States. The association between NAFLD and quality of life (QOL) remains unclear. These data are important to estimate the burden of illness in NAFLD. The aim was to report QOL scores of adults with NAFLD and examine the association between NAFLD severity and QOL. QOL data were collected from adults with NAFLD enrolled in the Nonalcoholic Steatohepatitis Clinical Research Network using the Short Form 36 (SF-36) survey, and scores were compared with normative U.S. population scores. Liver biopsy histology was reviewed by a central pathology committee. A total of 713 subjects with NAFLD (male = 269, female = 444) were included. Mean age of subjects was 48.3 years; 61% had definite nonalcoholic steatohepatitis (NASH), and 28% had bridging fibrosis or cirrhosis. Diabetes was present in 27% of subjects. Subjects with NAFLD had worse physical (mean, 45.2) and mental health scores (mean, 47.6) compared with the U.S. population with (mean, 50) and without (physical, 55.8; mental, 52.5) chronic illness. Subjects with NASH reported lower physical health compared with subjects with fatty liver disease without NASH (44.5 versus 47.1, P = 0.02). Subjects with cirrhosis had significantly (P < 0.001) poorer physical health scores (38.4) than subjects with no (47.6), mild (46.2), moderate (44.6), or bridging fibrosis (44.6). Cirrhosis was associated with poorer physical health after adjusting for potential confounders. Mental health scores did not differ between participants with and without NASH or by degree of fibrosis.
Adults with NAFLD have a significant decrement in QOL. Treatment of NAFLD should incorporate strategies to improve QOL, especially physical health.
非酒精性脂肪性肝病（NAFLD）是美国最常见的慢性肝病。NAFLD与生活质量（QOL）之间的关联仍不明确。这些数据对于评估NAFLD的疾病负担很重要。目的是报告NAFLD成人的生活质量得分，并研究NAFLD严重程度与生活质量之间的关联。使用简短健康调查问卷（SF - 36）从参加非酒精性脂肪性肝炎临床研究网络的NAFLD成人中收集生活质量数据，并将得分与美国正常人群得分进行比较。肝活检组织学由中央病理委员会进行审查。共纳入713例NAFLD患者（男性269例，女性444例）。受试者的平均年龄为48.3岁；61%患有明确的非酒精性脂肪性肝炎（NASH），28%有桥接纤维化或肝硬化。27%的受试者患有糖尿病。与患有慢性疾病（平均得分50）和未患慢性疾病（身体得分55.8；心理得分52.5）的美国人群相比，NAFLD患者的身体（平均得分45.2）和心理健康得分（平均得分47.6）更差。与无NASH的脂肪性肝病患者相比，NASH患者报告的身体健康状况更低（44.5对47.1，P = 0.02）。与无纤维化（47.6）、轻度纤维化（46.2）、中度纤维化（44.6）或桥接纤维化（44.6）的受试者相比，肝硬化患者的身体健康得分显著更低（P < 0.001，38.4）。在调整潜在混杂因素后，肝硬化与较差的身体健康相关。有和无NASH的参与者之间或按纤维化程度划分的心理健康得分没有差异。
NAFLD成人的生活质量有显著下降。NAFLD的治疗应纳入改善生活质量的策略，尤其是身体健康方面。
