Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
PLoS One. 2013 May 3;8(5):e62504. doi: 10.1371/journal.pone.0062504. Print 2013.
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide and its progressive form, steatohepatitis, will be the leading indication for liver transplant by 2020. While risk factors for steatohepatitis have been identified, little work has been performed to identify factors protective against NAFLD development.
This study sought to identify factors predictive of normal liver histology in a bariatric cohort.
Patients undergoing weight loss surgery with liver biopsies at the time of surgery were included. Patients with other causes of chronic liver disease were excluded.
One hundred fifty-nine patients were included. Forty-nine patients had normal liver histology and 110 patients had NAFLD. Several previously identified factors associated with normal liver histology were found. Black race was the strongest predictor of the absence of NAFLD with an odds ratio (OR) of 6.8, 95% confidence interval (CI) 2.4-18.9. Low HOMA-IR was also associated with normal histology (OR 1.4, 95% CI 1.03-1.9). In contrast, low HDL was associated with a decreased chance of normal histology (OR 0.38, 95% CI 0.05-0.83). Interestingly, a novel protective factor, the absence of obstructive sleep apnea (OSA) was strongly associated with normal histology (OR 5.6, 95% CI 2.0-16.1). In multivariate regression controlling for BMI, black race, absence of OSA, low HOMA-IR and low ALT independently predicted normal liver histology with an area under the ROC curve of 0.85.
Our study confirmed several factors associated with normal liver histology, including black race and identified a novel factor, absence of OSA. Further evaluation of these factors will allow for improved understanding of the pathogenesis of NAFLD.
非酒精性脂肪性肝病（NAFLD）是全球最常见的肝病病因，其进展形式——脂肪性肝炎，到 2020 年将成为肝移植的主要适应证。虽然已经确定了脂肪性肝炎的危险因素，但对于预防 NAFLD 发生的保护因素的研究却很少。
本研究旨在确定肥胖患者队列中预测正常肝脏组织学的因素。
纳入了接受减肥手术且术中进行肝脏活检的患者。排除了有其他原因导致的慢性肝病的患者。
共纳入 159 例患者。其中 49 例患者的肝脏组织学正常，110 例患者患有 NAFLD。发现了一些与正常肝脏组织学相关的已确定的因素。黑种人是 NAFLD 缺失的最强预测因素，其优势比（OR）为 6.8，95%置信区间（CI）为 2.4-18.9。低 HOMA-IR 也与正常组织学相关（OR 1.4，95%CI 1.03-1.9）。相反，低 HDL 与正常组织学的可能性降低相关（OR 0.38，95%CI 0.05-0.83）。有趣的是，一个新的保护因素，即不存在阻塞性睡眠呼吸暂停（OSA），与正常组织学有强烈相关性（OR 5.6，95%CI 2.0-16.1）。在多元回归中，控制 BMI、黑种人、无 OSA、低 HOMA-IR 和低 ALT 后，这些因素独立预测正常肝脏组织学，ROC 曲线下面积为 0.85。
本研究证实了与正常肝脏组织学相关的几个因素，包括黑种人，并确定了一个新的因素，即不存在 OSA。进一步评估这些因素将有助于更好地理解 NAFLD 的发病机制。
