Tomeno Wataru, Kawashima Keigo, Yoneda Masato, Saito Satoru, Ogawa Yuji, Honda Yasushi, Kessoku Takaomi, Imajo Kento, Mawatari Hironori, Fujita Koji, Saito Satoru, Hirayasu Yoshio, Nakajima Atsushi
Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
J Gastroenterol Hepatol. 2015 Jun;30(6):1009-14. doi: 10.1111/jgh.12897.
Major depressive disorder (MDD) is an important public health problem, and it is often comorbid with many chronic diseases. The purpose of this study was to identify the clinical features of non-alcoholic fatty liver disease (NAFLD) patients comorbid with MDD and to investigate the influence of MDD on the effect of treatment in patients with NAFLD.
A total of 258 patients with biopsy-proven NAFLD were included. MDD was diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision. The patients were followed up for 48 weeks under standard care for NAFLD, which consisted mainly of lifestyle modification.
There were 32 patients comorbid with MDD. They were characterized by more severe histological steatosis and higher NAFLD activity score, and also significantly higher levels of serum aminotransferase, γ-glutamyl transpeptidase and ferritin, than age-and-sex-matched NAFLD patients without MDD. Moreover, NAFLD patients with MDD showed poor response to the standard care for NAFLD, in body weight loss and in other parameters. Particularly, NAFLD patients with unstable MDD (not in full/partial remission) showed severe resistance to the treatment.
This is the first study to demonstrate the clinical features and response to therapy of NAFLD patients comorbid with MDD. The comorbid state of MDD was associated with more severe histological liver steatosis and worse treatment outcomes in patients with NAFLD. Further investigations are required to develop new lifestyle modification programs that enable NAFLD patients with MDD to achieve the treatment goal.
重度抑郁症（MDD）是一个重要的公共卫生问题，且常与多种慢性疾病共存。本研究旨在确定合并MDD的非酒精性脂肪性肝病（NAFLD）患者的临床特征，并探讨MDD对NAFLD患者治疗效果的影响。
共纳入258例经活检证实为NAFLD的患者。根据《精神疾病诊断与统计手册》第4版修订版的标准诊断MDD。患者在主要包括生活方式改变的NAFLD标准治疗下随访48周。
有32例患者合并MDD。与年龄和性别匹配的无MDD的NAFLD患者相比，他们的组织学脂肪变性更严重，NAFLD活动评分更高，血清转氨酶、γ-谷氨酰转肽酶和铁蛋白水平也显著更高。此外，合并MDD的NAFLD患者在体重减轻和其他参数方面对NAFLD标准治疗的反应较差。特别是，MDD不稳定（未完全/部分缓解）的NAFLD患者对治疗表现出严重抵抗。
这是第一项证明合并MDD的NAFLD患者临床特征和治疗反应的研究。MDD的共存状态与NAFLD患者更严重的组织学肝脂肪变性和更差的治疗结果相关。需要进一步研究以制定新的生活方式改变方案，使合并MDD的NAFLD患者能够实现治疗目标。
