Önnerhag Kristina, Nilsson Peter M, Lindgren Stefan
Department of Gastroenterology and Hepatology, Skåne University Hospital , Malmö , Sweden.
Scand J Gastroenterol. 2014 Sep;49(9):1111-8. doi: 10.3109/00365521.2014.934911. Epub 2014 Jul 3.
Our aims were to investigate the natural history of biopsy-proven non-alcoholic fatty liver disease (NAFLD) in Sweden, its associated complications, the clinical and biochemical factors associated with more advanced liver disease and the survival rate with a mean follow-up time of 27 years.
All subjects participating in the population-based prospective cohort study Malmö Preventive Project (MPP) from 1974 to 1992 who had undergone liver biopsy with the diagnosis of NAFLD were included. The remaining MPP cohort was used as a control group. Subjects with other liver diseases and alcohol overconsumption were excluded. A panel of blood tests was analyzed in the MPP cohort. Follow-up of the NAFLD patients included studies of medical records, pathology records and mortality rates from the Swedish National Board of Health and Welfare's register until the end of 2011.
A total of 36 patients were diagnosed with biopsy-proven NAFLD. Median follow-up time was 27.0 years (6.32-35.3). Nine patients (25%) were diagnosed with cirrhosis and five (14%) with hepatocellular cancer, all with a previous diagnosis of cirrhosis. There were significant differences in liver function tests, insulin resistance (as homeostasis model assessment of insulin resistance) and body mass index (BMI) in patients with NAFLD compared with the control group. Mortality in the NAFLD group was significantly higher, 58.3% compared to 33.8% (p = 0.004). Hepatocellular cancer accounted for 23.8% of all deaths in the NAFLD group, compared to 0.7% (p = 0.000).
NAFLD can progress to advanced liver disease, including cirrhosis, with a higher than expected mortality and incidence of hepatocellular cancer.
我们的目标是调查瑞典经活检证实的非酒精性脂肪性肝病（NAFLD）的自然病程、其相关并发症、与更晚期肝病相关的临床和生化因素以及平均随访27年的生存率。
纳入1974年至1992年参与基于人群的前瞻性队列研究马尔默预防项目（MPP）且经肝活检诊断为NAFLD的所有受试者。其余MPP队列用作对照组。排除患有其他肝病和饮酒过量的受试者。对MPP队列进行了一组血液检测分析。对NAFLD患者的随访包括对医疗记录、病理记录以及瑞典国家卫生和福利委员会登记处直至2011年底的死亡率进行研究。
共有36例患者经活检证实患有NAFLD。中位随访时间为27.0年（6.32 - 35.3年）。9例患者（25%）被诊断为肝硬化，5例（14%）被诊断为肝细胞癌，所有肝细胞癌患者之前均被诊断为肝硬化。与对照组相比，NAFLD患者的肝功能检查、胰岛素抵抗（作为胰岛素抵抗的稳态模型评估）和体重指数（BMI）存在显著差异。NAFLD组的死亡率显著更高，为58.3%，而对照组为33.8%（p = 0.004）。肝细胞癌占NAFLD组所有死亡病例的23.8%，而对照组为0.7%（p = 0.000）。
NAFLD可进展为晚期肝病，包括肝硬化，其死亡率和肝细胞癌发病率高于预期。
