Le Michael H, Devaki Pardha, Ha Nghiem B, Jun Dae Won, Te Helen S, Cheung Ramsey C, Nguyen Mindie H
Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, United States of America.
Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH, United States of America.
PLoS One. 2017 Mar 27;12(3):e0173499. doi: 10.1371/journal.pone.0173499. eCollection 2017.
In the United States, non-alcoholic fatty liver disease (NAFLD) is the most common liver disease and associated with higher mortality according to data from earlier National Health and Nutrition Examination Survey (NHANES) 1988-1994. Our goal was to determine the NAFLD prevalence in the recent 1999-2012 NHANES, risk factors for advanced fibrosis (stage 3-4) and mortality. NAFLD was defined as having a United States Fatty Liver Index (USFLI) > 30 in the absence of heavy alcohol use and other known liver diseases. The probability of low/high risk of having advanced fibrosis was determined by the NAFLD Fibrosis Score (NFS). In total, 6000 persons were included; of which, 30.0% had NAFLD and 10.3% of these had advanced fibrosis. Five and eight-year overall mortality in NAFLD subjects with advanced fibrosis was significantly higher than subjects without NAFLD ((18% and 35% vs. 2.6% and 5.5%, respectively) but not NAFLD subjects without advanced fibrosis (1.1% and 2.8%, respectively). NAFLD with advanced fibrosis (but not those without) is an independent predictor for mortality on multivariate analysis (HR = 3.13, 95% CI 1.93-5.08, p<0.001). In conclusion, in this most recent NHANES, NAFLD prevalence remains at 30% with 10.3% of these having advanced fibrosis. NAFLD per se was not a risk factor for increased mortality, but NAFLD with advanced fibrosis was. Mexican American ethnicity was a significant risk factor for NAFLD but not for advanced fibrosis or increased mortality.
在美国，根据1988 - 1994年早期国家健康与营养检查调查（NHANES）的数据，非酒精性脂肪性肝病（NAFLD）是最常见的肝脏疾病，且与较高的死亡率相关。我们的目标是确定1999 - 2012年最新NHANES中的NAFLD患病率、晚期纤维化（3 - 4期）的危险因素以及死亡率。NAFLD被定义为在美国脂肪肝指数（USFLI）> 30且无大量饮酒及其他已知肝脏疾病的情况下。晚期纤维化低/高风险的概率由NAFLD纤维化评分（NFS）确定。总共纳入了6000人；其中，30.0%患有NAFLD，这些患者中有10.3%患有晚期纤维化。患有晚期纤维化的NAFLD患者的5年和8年总死亡率显著高于无NAFLD的患者（分别为18%和35% vs. 2.6%和5.5%），但高于无晚期纤维化的NAFLD患者（分别为1.1%和2.8%）。多因素分析显示，伴有晚期纤维化的NAFLD（而非无晚期纤维化的NAFLD）是死亡率的独立预测因素（HR = 3.13，95% CI 1.93 - 5.08，p < 0.001）。总之，在此次最新的NHANES中，NAFLD患病率仍为30%，其中10.3%患有晚期纤维化。NAFLD本身并非死亡率增加的危险因素，但伴有晚期纤维化的NAFLD是。墨西哥裔美国人种族是NAFLD的重要危险因素，但不是晚期纤维化或死亡率增加的危险因素。
