Center for Digestive Diseases, Unit of Hepatology, Karolinska University Hospital, Stockholm, Sweden.
Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
Liver Int. 2016 Nov;36(11):1688-1695. doi: 10.1111/liv.13144. Epub 2016 Apr 28.
BACKGROUND & AIMS: High levels of ferritin in patients with non-alcoholic fatty liver disease (NAFLD) are associated with significant fibrosis and higher NAFLD activity score (NAS). It is unclear if this association has an impact on mortality. We investigated if high levels of ferritin, with or without iron overload, were associated with an increased mortality in NAFLD.
We included 222 patients between 1979 and 2009 with biopsy-proven NAFLD and available serum ferritin concentrations. The cohort was divided into 'high' (n = 89) and 'normal' (n = 133) ferritin values, using a cut-point of 350 μg/L in males, and 150 μg/L in females, and stratified upon iron overload status. Data on mortality were obtained from a national, population-based register. Poisson regression was used to estimate hazard ratios for mortality. The estimates were adjusted for age at biopsy, sex, smoking, BMI, diabetes, hypertension, cardiovascular disease and fibrosis stage at the time of biopsy.
The median follow-up time was 15.6 years (range: 0.5-34.2). Patients with high ferritin had more advanced fibrosis and higher NAS than patients with normal ferritin (P < 0.05). Fifteen years after diagnosis, and after adjusting for confounders, the high-ferritin group showed an increasingly higher mortality that was statistically significant (Hazard ratio = 1.10 per year, 95% Confidence interval 1.01-1.21, P < 0.05). There was no difference in mortality between patients with different iron overload patterns.
High levels of ferritin are associated with a long-term increased risk of death.
非酒精性脂肪性肝病（NAFLD）患者的铁蛋白水平较高与明显的纤维化和更高的 NAFLD 活动评分（NAS）相关。目前尚不清楚这种关联是否会对死亡率产生影响。我们研究了铁蛋白水平升高（无论是否伴有铁过载）是否与 NAFLD 患者的死亡率增加相关。
我们纳入了 1979 年至 2009 年间经活检证实的 222 例 NAFLD 患者，且这些患者的血清铁蛋白浓度可获取。使用男性 350μg/L 和女性 150μg/L 的截断值，将队列分为“高”（n=89）和“正常”（n=133）铁蛋白值，并根据铁过载状态进行分层。通过全国性的基于人群的登记处获取死亡率数据。使用泊松回归估计死亡率的风险比。估计值根据活检时的年龄、性别、吸烟、BMI、糖尿病、高血压、心血管疾病和纤维化分期进行了调整。
中位随访时间为 15.6 年（范围：0.5-34.2）。与铁蛋白正常的患者相比，铁蛋白高的患者纤维化程度更严重，NAS 更高（P＜0.05）。诊断后 15 年，在调整混杂因素后，高铁蛋白组的死亡率呈逐渐升高趋势，且具有统计学意义（风险比=每年 1.10，95%置信区间 1.01-1.21，P＜0.05）。不同铁过载模式的患者之间死亡率没有差异。
铁蛋白水平升高与长期死亡风险增加相关。
