Department of Pediatric Gastroenterology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Dig Dis Sci. 2010 Sep;55(9):2644-50. doi: 10.1007/s10620-009-1075-y. Epub 2009 Dec 5.
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the Western world. It encompasses a spectrum of disease ranging from simple steatosis to nonalcoholic steatohepatitis (NASH). Growing evidence links NAFLD to cardiovascular (CV) disease; however, the association between the histologic severity of NAFLD and CV risk remains poorly understood.
To assess the relationship between severity of liver injury and CV risk markers in a large, well-characterized group of patients with biopsy-proven NAFLD.
Our cohort consisted of 83 consecutive patients undergoing liver biopsy for clinical suspicion of NAFLD. Patients were subsequently divided into three groups: normal biopsy (n=11) simple steatosis (n=36), and NASH (n=36). CV risk markers included: triglyceride/high-density lipoprotein (HDL), total cholesterol/HDL, and low-density lipoprotein/HDL ratios.
All lipid ratios were found to be significantly associated with NAFLD (p<0.05) after adjusting for age and gender. More importantly, there was a stepwise, statistically significant increase in lipid ratios from patients with normal biopsies to patients with simple steatosis to those with NASH (p<0.05). A positive correlation was found between the lipid ratios and NAFLD activity score (NAS) as well as the individual histological features of the NAS (steatosis, inflammation, and ballooning) with the strongest correlation being with NAS (rho (95% CI) 0.41 (0.21, 0.62), p<0.001).
In patients with NAFLD, the histologic severity of liver injury and inflammation is strongly associated with an increased CV risk and an atherogenic lipid profile.
非酒精性脂肪性肝病（NAFLD）是西方世界最常见的慢性肝病。它包含了从单纯性脂肪变性到非酒精性脂肪性肝炎（NASH）的一系列疾病谱。越来越多的证据将 NAFLD 与心血管（CV）疾病联系起来；然而，NAFLD 的组织学严重程度与 CV 风险之间的关系仍知之甚少。
在一组经活检证实的 NAFLD 大样本、特征明确的患者中，评估肝损伤严重程度与 CV 风险标志物之间的关系。
我们的队列包括 83 例因临床怀疑 NAFLD 而行肝活检的连续患者。随后，患者被分为三组：正常活检组（n=11）、单纯性脂肪变性组（n=36）和 NASH 组（n=36）。CV 风险标志物包括甘油三酯/高密度脂蛋白（HDL）、总胆固醇/HDL 和低密度脂蛋白/HDL 比值。
调整年龄和性别后，所有血脂比值均与 NAFLD 显著相关（p<0.05）。更重要的是，从正常活检患者到单纯性脂肪变性患者再到 NASH 患者，血脂比值呈逐步、统计学显著增加（p<0.05）。血脂比值与 NAFLD 活动评分（NAS）以及 NAS 的各个组织学特征（脂肪变性、炎症和气球样变）呈正相关，与 NAS 的相关性最强（rho（95%CI）0.41（0.21，0.62），p<0.001）。
在 NAFLD 患者中，肝损伤和炎症的组织学严重程度与 CV 风险增加和动脉粥样硬化性血脂谱密切相关。
