Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA.
Hepatology. 2013 Apr;57(4):1357-65. doi: 10.1002/hep.26156. Epub 2013 Jan 25.
The clinical and public health significance of nonalcoholic fatty liver disease (NAFLD) is not well established. We investigated the long-term effect of NAFLD on mortality. This analysis utilized the National Health and Nutrition Examination Survey conducted in 1988-1994 and subsequent follow-up data for mortality through December 31, 2006. NAFLD was defined by ultrasonographic detection of hepatic steatosis in the absence of other known liver diseases. The presence and severity of hepatic fibrosis in subjects with NAFLD was determined by the NAFLD fibrosis score (NFS), the aspartate aminotransferase to platelet ratio index (APRI), and FIB-4 score. Of 11,154 participants, 34.0% had NAFLD--the majority (71.7%) had NFS consistent with lack of significant fibrosis (NFS <-1.455), whereas 3.2% had a score indicative of advanced fibrosis (NFS >0.676). After a median follow-up of 14.5 years, NAFLD was not associated with higher mortality (age- and sex-adjusted hazard ratio [HR]: 1.05; 95% confidence interval [CI]: 0.93-1.19). In contrast, there was a progressive increase in mortality with advancing fibrosis scores. Compared to subjects without fibrosis, those with a high probability of advanced fibrosis had a 69% increase in mortality (for NFS: HR, 1.69, 95% CI: 1.09-2.63; for APRI: HR, 1.85, 95% CI: 1.02-3.37; for FIB-4: HR, 1.66, 95% CI: 0.98-2.82) after adjustment for other known predictors of mortality. These increases in mortality were almost entirely from cardiovascular causes (for NFS: HR, 3.46, 95% CI: 1.91-6.25; for APRI: HR, 2.53, 95% CI: 1.33-4.83; for FIB-4: HR, 2.68, 95% CI: 1.44-4.99).
Ultrasonography-diagnosed NAFLD is not associated with increased mortality. However, advanced fibrosis, as determined by noninvasive fibrosis marker panels, is a significant predictor of mortality, mainly from cardiovascular causes, independent of other known factors.
非酒精性脂肪性肝病（NAFLD）的临床和公共卫生意义尚未明确。本研究旨在探讨 NAFLD 对死亡率的长期影响。
本分析利用了 1988-1994 年进行的全国健康和营养调查（NHANES）以及截至 2006 年 12 月 31 日的后续死亡率随访数据。NAFLD 通过超声检查无其他已知肝病的情况下检测到肝脂肪变性来定义。NAFLD 患者肝纤维化的存在和严重程度通过 NAFLD 纤维化评分（NFS）、天门冬氨酸氨基转移酶与血小板比值指数（APRI）和 FIB-4 评分来确定。在 11154 名参与者中，34.0%患有 NAFLD-大多数（71.7%）NFS 提示无明显纤维化（NFS <-1.455），而 3.2%的评分提示存在进展性纤维化（NFS >0.676）。中位随访 14.5 年后，NAFLD 与死亡率升高无关（年龄和性别校正的危险比[HR]：1.05；95%置信区间[CI]：0.93-1.19）。相比之下，纤维化评分越高，死亡率呈递增趋势。与无纤维化的患者相比，具有进展性纤维化高概率的患者死亡率增加了 69%（NFS：HR，1.69，95%CI：1.09-2.63；APRI：HR，1.85，95%CI：1.02-3.37；FIB-4：HR，1.66，95%CI：0.98-2.82），校正其他已知死亡率预测因素后。这些死亡率的增加几乎完全归因于心血管原因（NFS：HR，3.46，95%CI：1.91-6.25；APRI：HR，2.53，95%CI：1.33-4.83；FIB-4：HR，2.68，95%CI：1.44-4.99）。
超声诊断的 NAFLD 与死亡率增加无关。然而，非侵入性纤维化标志物谱确定的进展性纤维化是死亡率的重要预测因素，主要是心血管原因，独立于其他已知因素。
