Columbia University, College of Physicians & Surgeons New York, NY, USA.
Hepatology. 2012 Oct;56(4):1580-4. doi: 10.1002/hep.26031.
To evaluate the association between non-alcoholic fatty liver disease and all cause and cause specific mortality in a representative sample of the US general population.
Prospective cohort study.
US Third National Health and Nutrition Examination Survey (NHANES III: 1988–94) with follow-up of mortality to 2006.
11,371 adults aged 20–74 participating in the Third National Health and Nutrition Examination Survey, with assessment of hepatic steatosis.
Mortality from all causes, cardiovascular disease, cancer, and liver disease (up to 18 years of follow-up).
The prevalence of non-alcoholic fatty liver disease with and without increased levels of liver enzymes in the population was 3.1% and 16.4%, respectively. Compared with participants without steatosis, those with non-alcoholic fatty liver disease but normal liver enzyme levels had multivariate adjusted hazard ratios for deaths from all causes of 0.92 (95% confidence interval 0.78 to 1.09), from cardiovascular disease of 0.86 (0.67 to 1.12), from cancer of 0.92 (0.67 to 1.27), and from liver disease of 0.64 (0.12 to 3.59). Compared with participants without steatosis, those with non-alcoholic fatty liver disease and increased liver enzyme levels had adjusted hazard ratios for deaths from all causes of 0.80 (0.52 to 1.22), from cardiovascular disease of 0.59 (0.29 to 1.20), from cancer of 0.53 (0.26 to 1.10), and from liver disease of 1.17 (0.15 to 8.93).
Non-alcoholic fatty liver disease was not associated with an increased risk of death from all causes, cardiovascular disease, cancer, or liver disease
BACKGROUND & AIMS: The relative frequency of nonalcoholic steatohepatitis (NASH) as an indication for liver transplantation and comparative outcomes following transplantation are poorly understood.
We analyzed the Scientific Registry of Transplant Recipients for primary adult liver transplant recipients from 2001 to 2009.
From 2001 to 2009, 35,781 patients underwent a primary liver transplant, including 1959 for who NASH was the primary or secondary indication. The percentage of patients undergoing a liver transplant for NASH increased from 1.2% in 2001 to 9.7% in 2009. NASH is now the third most common indication for liver transplantation in the United States. No other indication for liver transplantation increased in frequency during the study period. Compared with other indications for liver transplantation, recipients with NASH are older (58.5±8.0 vs 53.0±8.9 years; P<.001), have a larger body mass index (>30 kg/m2) (63% vs 32%; P<.001), are more likely to be female (47% vs 29%; P<.001), and have a lower frequency of hepatocellular carcinoma (12% vs 19%; P<.001). Survival at 1 and 3 years after liver transplantation for NASH was 84% and 78%, respectively, compared with 87% and 78% for other indications (P=.67). Patient and graft survival for liver recipients with NASH were similar to values for other indications after adjusting for level of creatinine, sex, age, and body mass index.
NASH is the third most common indication for liver transplantation in the United States and is on a trajectory to become the most common. Outcomes for patients undergoing a liver transplant for NASH are similar to those for other indications
在具有代表性的美国普通人群样本中评估非酒精性脂肪肝疾病与全因和特定原因死亡率之间的关联。
前瞻性队列研究。
美国第三次国家健康和营养检查调查（NHANES III：1988-1994 年），随访死亡率至 2006 年。
参加第三次国家健康和营养检查调查的 11371 名 20-74 岁成年人，评估肝脂肪变性。
全因死亡率、心血管疾病、癌症和肝脏疾病（18 年随访）。
人群中非酒精性脂肪性肝病伴或不伴肝酶升高的患病率分别为 3.1%和 16.4%。与无脂肪变性的参与者相比，非酒精性脂肪性肝病但肝酶水平正常的患者全因死亡的多变量调整危险比为 0.92（95%置信区间 0.78 至 1.09），心血管疾病死亡的危险比为 0.86（0.67 至 1.12），癌症死亡的危险比为 0.92（0.67 至 1.27），肝脏疾病死亡的危险比为 0.64（0.12 至 3.59）。与无脂肪变性的参与者相比，非酒精性脂肪性肝病伴肝酶升高的患者全因死亡的调整危险比为 0.80（0.52 至 1.22），心血管疾病死亡的危险比为 0.59（0.29 至 1.20），癌症死亡的危险比为 0.53（0.26 至 1.10），肝脏疾病死亡的危险比为 1.17（0.15 至 8.93）。
非酒精性脂肪性肝病与全因、心血管疾病、癌症或肝脏疾病死亡的风险增加无关。
人们对非酒精性脂肪性肝炎（NASH）作为肝移植指征的相对频率以及移植后的比较结果了解甚少。
我们分析了 2001 年至 2009 年的科学注册移植受者。
2001 年至 2009 年，35781 名患者接受了原发性成人肝移植，其中 1959 名患者的 NASH 是主要或次要指征。接受肝移植治疗 NASH 的患者比例从 2001 年的 1.2%增加到 2009 年的 9.7%。NASH 现在是美国第三大常见的肝移植指征。在研究期间，没有其他肝移植指征的频率增加。与其他肝移植指征相比，NASH 患者年龄较大（58.5±8.0 岁 vs 53.0±8.9 岁；P<.001），体重指数较高（>30 kg/m2）（63% vs 32%；P<.001），女性比例较高（47% vs 29%；P<.001），肝细胞癌的发生率较低（12% vs 19%；P<.001）。NASH 患者肝移植后 1 年和 3 年的生存率分别为 84%和 78%，而其他指征的生存率分别为 87%和 78%（P=.67）。在调整了肌酐水平、性别、年龄和体重指数后，NASH 肝移植患者的患者和移植物生存率与其他指征相似。
NASH 是美国第三大常见的肝移植指征，并且有成为最常见的趋势。接受 NASH 肝移植的患者的结局与其他指征相似。
