Dogan Serkan, Celikbilek Mehmet, Yilmaz Yunus K, Sarikaya Savas, Zararsiz Gokmen, Serin Halil I, Borekci Elif, Akyol Lütfi, Pirti Ilyas, Davarci Sena E
aDepartment of Gastroenterology, Mardin State Hospital, Mardin Departments of bGastroenterology cCardiovascular Surgery dCardiology eRadiology fInternal Medicine, School of Medicine, Bozok University, Yozgat gDepartment of Biostatistics, School of Medicine, Hacettepe University, Ankara, Turkey.
Eur J Gastroenterol Hepatol. 2015 Mar;27(3):298-304. doi: 10.1097/MEG.0000000000000286.
Nonalcoholic fatty liver disease (NAFLD) is being increasingly recognized as the most common cause of chronic liver disease worldwide. It has been shown that NAFLD in adults is associated with increased risk of coronary heart disease (CHD). Because of the limitations of liver biopsy, noninvasive scoring indexes such as the NAFLD fibrosis score (NFS) were developed. The Framingham risk score (FRS) provides an estimate of CHD risk. In our study we aimed to investigate whether the severity of liver fibrosis estimated with the NFS is associated with a higher risk of CHD among individuals with ultrasonography-diagnosed NAFLD.
A total of 155 patients and controls (81 patients with NAFLD and 74 controls) with ages ranging from 18 to 70 years were enrolled in this cross-sectional prospective study. Demographic, anthropometric, clinical, and laboratory data were obtained from each individual. The NAFLD patients were divided into subgroups on the basis of the severity of fatty liver. The FRS and NFS were adopted to predict the risk of CHD and the severity of hepatic fibrosis.
In our study, we found that the FRS was higher in NAFLD patients than in controls (P<0.05). According to the FRS category, NFSs were higher in the intermediate/high probability CHD risk group in NAFLD (P<0.05). In multiple models, only age, sex, cholesterol, and HDL were independently associated with intermediate/high CHD risk (P<0.05). We also found a positive correlation between the NFS and the FRS (r=0.373, P<0.001). The optimum NFS cutoff point for identifying intermediate/high CHD risk in NAFLD patients was -2.1284, with a sensitivity and specificity of 95.20 and 48.30%, respectively. The predictive performance of the NFS in the determination of intermediate/high CHD risk in NAFLD patients was found to be 72% based on the area under the curve value.
The FRS is associated with the NFS in NAFLD. The assessment of liver fibrosis may be useful for the risk stratification of CHD in the absence of liver biopsy in clinical practice.
非酒精性脂肪性肝病（NAFLD）日益被认为是全球慢性肝病的最常见病因。研究表明，成人NAFLD与冠心病（CHD）风险增加相关。由于肝活检存在局限性，因此开发了诸如NAFLD纤维化评分（NFS）等非侵入性评分指标。弗雷明汉风险评分（FRS）可用于评估CHD风险。在我们的研究中，我们旨在调查在超声诊断为NAFLD的个体中，用NFS评估的肝纤维化严重程度是否与CHD风险升高相关。
本横断面前瞻性研究共纳入了155例年龄在18至70岁之间的患者及对照（81例NAFLD患者和74例对照）。收集了每个人的人口统计学、人体测量学、临床和实验室数据。NAFLD患者根据脂肪肝的严重程度分为亚组。采用FRS和NFS来预测CHD风险和肝纤维化严重程度。
在我们的研究中，我们发现NAFLD患者的FRS高于对照组（P<0.05）。根据FRS分类，NAFLD中CHD风险为中/高概率组的NFS更高（P<0.05）。在多个模型中，仅年龄、性别、胆固醇和高密度脂蛋白与CHD中/高风险独立相关（P<0.05）。我们还发现NFS与FRS之间存在正相关（r=0.373，P<*0.001）。在NAFLD患者中识别CHD中/高风险的最佳NFS临界值为-2.1284，敏感性和特异性分别为95.20%和48.30%。基于曲线下面积值，发现NFS在确定NAFLD患者CHD中/高风险方面的预测性能为72%。
在NAFLD中，FRS与NFS相关。在临床实践中，在没有肝活检的情况下，肝纤维化评估可能有助于CHD的风险分层。
