Hagström Hannes, Nasr Patrik, Ekstedt Mattias, Kechagias Stergios, Stål Per, Bedossa Pierre, Hultcrantz Rolf
a Division of Hepatology, Center for Digestive Diseases , Karolinska University Hospital , Stockholm , Sweden.
b Department of Medicine , Huddinge, Karolinska Institutet , Stockholm , Sweden.
Scand J Gastroenterol. 2017 Jan;52(1):87-91. doi: 10.1080/00365521.2016.1230779. Epub 2016 Sep 10.
A new score for the histological severity of nonalcoholic fatty liver disease (NAFLD), called SAF (Steatosis, Activity and Fibrosis) has been developed. We aimed to evaluate the impact of this score on overall mortality.
We used data from 139 patients with biopsy-proven NAFLD. All biopsies were graded according to the SAF scoring system and disease severity was classified as mild, moderate or severe. Causes of death were extracted from a national, population-based register. A Cox regression model, adjusted for sex, body mass index (BMI) and diabetes mellitus type 2, was applied.
At baseline 35 patients presented with mild or moderate disease respectively, and 69 patients with severe disease. During follow-up (median 25.3 years, range 1.7-40.8) 74 patients died, 11 in the mild group (31%), 18 in the moderate group (51%) and 45 in the severe group (65%), p = .002. Compared to patients with mild disease, patients with moderate disease did not have a significant increase in overall mortality (HR 1.83, 95%CI 0.89-3.77, p = .10). Patients with severe disease had a significant increase in mortality (HR 2.65, 95%CI 1.19-5.93, p = .017). However, when adjusting for fibrosis stage, significance was lost (HR 1.85, 95%CI 0.76-4.54, p = .18). NASH, defined as per the FLIP algorithm, was not associated with mortality compared to not having NASH (HR 1.46, 95%CI 0.74-2.90, p = .28).
After adjustment for fibrosis, the SAF score was not associated with increased mortality in NAFLD. This finding should be corroborated in larger cohorts with similar follow-up time.
一种用于评估非酒精性脂肪性肝病（NAFLD）组织学严重程度的新评分系统——SAF（脂肪变性、炎症活动度和纤维化）已被开发出来。我们旨在评估该评分对总体死亡率的影响。
我们使用了139例经活检证实为NAFLD患者的数据。所有活检标本均根据SAF评分系统进行分级，疾病严重程度分为轻度、中度或重度。死亡原因从一个全国性的、基于人群的登记系统中提取。应用Cox回归模型，并对性别、体重指数（BMI）和2型糖尿病进行校正。
基线时，分别有35例患者患有轻度或中度疾病，69例患者患有重度疾病。在随访期间（中位时间25.3年，范围1.7 - 40.8年），74例患者死亡，轻度组11例（31%），中度组18例（51%），重度组45例（65%），p = 0.002。与轻度疾病患者相比，中度疾病患者的总体死亡率没有显著增加（风险比[HR] 1.83，95%置信区间[CI] 0.89 - 3.77，p = 0.10）。重度疾病患者的死亡率显著增加（HR 2.65，95%CI 1.19 - 5.93，p = 0.017）。然而，在对纤维化阶段进行校正后，这种显著性消失了（HR 1.85，95%CI 0.76 - 4.54，p = 0.18）。根据FLIP算法定义的非酒精性脂肪性肝炎（NASH）与非NASH患者相比，与死亡率无关（HR 1.46，95%CI 0.74 - 2.90，p = 0.28）。
在对纤维化进行校正后，SAF评分与NAFLD患者死亡率增加无关。这一发现应在具有相似随访时间的更大队列中得到证实。
