Munsterman Isabelle D, Smits Mark M, Andriessen Rene, van Nieuwkerk Carin M J, Bloemena Elisabeth, Mulder Chris J J, Tjwa Eric T T L, van Geenen Erwin J M
a Department of Gastroenterology and Hepatology , Radboud university medical center , Nijmegen , the Netherlands.
b Department of Gastroenterology and Hepatology , VU University Medical Center , Amsterdam , the Netherlands.
Scand J Gastroenterol. 2017 Aug;52(8):881-885. doi: 10.1080/00365521.2017.1315169. Epub 2017 Apr 27.
To assess the influence of smoking on histological disease severity and fibrosis in real-world NAFLD patients.
Consecutive NAFLD patients were identified with liver biopsies performed between 2008 and 2015. Characteristics such as smoking status and total number of pack years were collected. Biopsies were revised and BRUNT fibrosis and NAFLD activity score (NAS) determined. Patients with a high NAS (≥5) were compared to patients with a low NAS (<5) and with advanced fibrosis (stage 3-4) to patients with no-early fibrosis (stage 0-2). Patients with a history of smoking (current or past smoker) were defined ever smokers.
Fifty-six patients were included (mean age 49 ± 14.3, 68.9% males and 39.3% history of smoking). Ever smokers had a higher fibrosis score than never smokers; two (IQR 0-3) versus one (IQR 1-1.5) (p = .040). Patients with advanced fibrosis smoked significantly more pack years than patients with no-early fibrosis; 10.6 (IQR 0-25.8) versus 0 (IQR 0-7) (p = .011). There is a weak to moderate correlation between fibrosis stage and number of pack years (Spearman's Rho = 0.341, p = .012). There was no difference in NAS between never and ever smokers; 2.8 ± 1.5 versus 3.3 ± 1.4 (p = .205). Patients with NAS <5 had a median number of pack years of 0 (IQR 0-9) versus a median of 10.3 pack years (IQR 0-24) in patients with NAS ≥5 (p = .127).
Smoking is associated with severity of NAFLD-related liver fibrosis but not with histological disease severity. This supports the recommendation to cease smoking for NAFLD patients.
评估吸烟对现实世界中非酒精性脂肪性肝病（NAFLD）患者组织学疾病严重程度和纤维化的影响。
纳入2008年至2015年间接受肝活检的连续性NAFLD患者。收集吸烟状况和吸烟包年总数等特征。对活检标本进行复查并确定BRUNT纤维化和NAFLD活动评分（NAS）。将NAS高（≥5）的患者与NAS低（<5）的患者进行比较，将晚期纤维化（3 - 4期）患者与无早期纤维化（0 - 2期）患者进行比较。有吸烟史（当前吸烟者或既往吸烟者）的患者定义为曾经吸烟者。
纳入56例患者（平均年龄49±14.3岁，男性占68.9%，有吸烟史者占39.3%）。曾经吸烟者的纤维化评分高于从不吸烟者；分别为2（四分位间距0 - 3）和1（四分位间距1 - 1.5）（p = 0.040）。晚期纤维化患者的吸烟包年数显著多于无早期纤维化患者；分别为10.6（四分位间距0 - 25.8）和0（四分位间距0 - 7）（p = 0.011）。纤维化分期与吸烟包年数之间存在弱至中度相关性（斯皮尔曼等级相关系数=0.341，p = 0.012）。从不吸烟者和曾经吸烟者的NAS无差异；分别为2.8±1.5和3.3±1.4（p = 0.205）。NAS<5的患者吸烟包年数中位数为0（四分位间距0 - 9），而NAS≥5的患者吸烟包年数中位数为10.3包年（四分位间距0 - 24）（p = 0.127）。
吸烟与NAFLD相关肝纤维化的严重程度有关，但与组织学疾病严重程度无关。这支持了建议NAFLD患者戒烟。
