Miele Luca, Vallone Selenia, Cefalo Consuelo, La Torre Giuseppe, Di Stasi Carmine, Vecchio Fabio M, D'Agostino Magda, Gabrieli Maria L, Vero Vittoria, Biolato Marco, Pompili Maurizio, Gasbarrini Giovanni, Rapaccini Gianludovico, Amerio Pierluigi, De Simone Clara, Grieco Antonio
Institute of Internal Medicine, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy.
J Hepatol. 2009 Oct;51(4):778-86. doi: 10.1016/j.jhep.2009.06.008. Epub 2009 Jun 26.
BACKGROUND/AIMS: The association between NAFLD and psoriasis has never been explored in prospective epidemiological studies. The aim of this 2-phase study was to study the clinical features of NAFLD in patients with psoriasis.
Phase 1: Investigation of prevalence and characteristics of NAFLD in an unselected cohort of 142 adult Italian outpatients with psoriasis vulgaris. Phase 2: Comparison of the psoriasis cohort subgroup with NAFLD and an age- and body mass index-matched retrospective cohort of 125 non-psoriasis patients with biopsy proven NAFLD.
Based on histories, laboratory tests, and ultrasound studies, 84 (59.2%) received clinical diagnosis of NAFLD; 30 had factors potentially associated with liver disease other than NAFLD (e.g., viral hepatitis, significant ethanol, methotrexate use); and 28 (19.7%) had normal livers. Comparison of the normal-liver and NAFLD subgroups revealed that NAFLD in psoriasis patients (Ps-NAFLD) was significantly correlated with metabolic syndrome (p<0.05); obesity (p=0.043); hypercholesterolemia (p=0.029); hypertriglyceridemia (p<0.001); AST/ALT ratio >1 (p=0.019), and psoriatic arthritis (PsA) (p=0.036). The association with PsA remained significant after logistic regression analysis (OR=3.94 [CI, 1.07-14.46]). Compared with the retrospective non-psoriatic NAFLD cohort (controls), Ps-NAFLD patients (cases) were likely to have severe NAFLD reflected by non-invasive NAFLD Fibrosis Scores and AST/ALT >1.
NAFLD is highly prevalent among psoriasis patients, where it is closely associated with obesity (overall and abdominal), metabolic syndrome, and PsA, and more likely to cause severe liver fibrosis (compared with nonPs-NAFLD). Routine work-up for NAFLD may be warranted in patients with psoriasis, especially when potentially hepatotoxic drug therapy is being considered.
背景/目的：非酒精性脂肪性肝病（NAFLD）与银屑病之间的关联从未在前瞻性流行病学研究中被探讨过。这项两阶段研究的目的是研究银屑病患者中NAFLD的临床特征。
第一阶段：对142名患有寻常型银屑病的成年意大利门诊患者的未选择队列进行NAFLD患病率及特征调查。第二阶段：将患有NAFLD的银屑病队列亚组与125名经活检证实患有NAFLD的年龄和体重指数匹配的非银屑病患者回顾性队列进行比较。
根据病史、实验室检查和超声研究，84名（59.2%）患者获得了NAFLD的临床诊断；30名患者有除NAFLD之外可能与肝脏疾病相关的因素（如病毒性肝炎、大量饮酒、使用甲氨蝶呤）；28名（19.7%）患者肝脏正常。正常肝脏亚组与NAFLD亚组的比较显示，银屑病患者中的NAFLD（Ps-NAFLD）与代谢综合征（p<0.05）、肥胖（p=0.043）、高胆固醇血症（p=0.029）、高甘油三酯血症（p<0.001）、AST/ALT比值>1（p=0.019）以及银屑病关节炎（PsA）（p=0.036）显著相关。经逻辑回归分析后，与PsA的关联仍然显著（OR=3.94[CI，1.07-14.46]）。与回顾性非银屑病NAFLD队列（对照组）相比，Ps-NAFLD患者（病例组）更可能患有严重的NAFLD，这通过非侵入性NAFLD纤维化评分和AST/ALT>1反映出来。
NAFLD在银屑病患者中高度流行，在这些患者中它与肥胖（全身和腹部）、代谢综合征以及PsA密切相关，并且更有可能导致严重的肝纤维化（与非银屑病NAFLD相比）。对于银屑病患者，尤其是在考虑可能具有肝毒性的药物治疗时，对NAFLD进行常规检查可能是必要的。
