Dam-Larsen Sanne, Becker Ulrik, Franzmann Maria-Benedicte, Larsen Klaus, Christoffersen Per, Bendtsen Flemming
Gastroenterology Unit, Medical Section, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.
Scand J Gastroenterol. 2009;44(10):1236-43. doi: 10.1080/00365520903171284.
There is increasing focus on non-alcoholic fatty liver disease (NAFLD). The aim of the present study was to conduct a long-term clinical follow-up of patients with biopsy-confirmed fatty liver without inflammation or significant fibrosis (pure fatty liver), to analyse for potential risk factors at the time of index liver biopsy important for survival and the development of cirrhosis and to describe the causes of death.
Patients were linked through their personal identification number to the Danish National Registry of Patients and the Register of Causes of Death. All admissions, discharge diagnoses and causes of death during follow-up were collected. All surviving patients were invited to a clinical follow-up.
The follow-up period was 20.4 and 21.0 years, respectively, for the NAFLD and alcoholic fatty liver disease (AFLD) groups. Two NAFLD patients (1.2%) developed cirrhosis during the follow-up period versus 54 (22%) AFLD patients. Sixty-four percent of 178 surviving patients out of an original cohort of 417 patients attended the clinical follow-up. In NAFLD patients, none of the risk factors studied was significant in relation to the risk of death. Patients with AFLD died primarily from cirrhosis and other alcohol-related disorders, whereas in patients with NAFLD the main causes of death were cardiovascular disease and cancer.
For patients with pure non-alcoholic fatty liver, survival was good and independent of the histological, clinical and biochemical characteristics at the time of biopsy; the main causes of death were cardiovascular disease and cancer.
非酒精性脂肪性肝病（NAFLD）日益受到关注。本研究的目的是对经活检证实为无炎症或显著纤维化的脂肪肝患者（单纯性脂肪肝）进行长期临床随访，分析首次肝活检时对生存及肝硬化发生具有重要意义的潜在危险因素，并描述死亡原因。
通过个人识别码将患者与丹麦国家患者登记处及死亡原因登记处进行关联。收集随访期间所有的入院情况、出院诊断及死亡原因。邀请所有存活患者进行临床随访。
NAFLD组和酒精性脂肪性肝病（AFLD）组的随访期分别为20.4年和21.0年。随访期间，2例NAFLD患者（1.2%）发生肝硬化，而AFLD患者有54例（22%）。在最初的417例患者队列中，178例存活患者中有64%参加了临床随访。在NAFLD患者中，所研究的危险因素均与死亡风险无显著相关性。AFLD患者主要死于肝硬化和其他酒精相关疾病，而NAFLD患者的主要死亡原因是心血管疾病和癌症。
对于单纯性非酒精性脂肪肝患者，生存率良好，且与活检时的组织学、临床及生化特征无关；主要死亡原因是心血管疾病和癌症。
