Kim Gyuri, Kim Kwang Joon, Rhee Yumie, Lim Sung-Kil
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
PLoS One. 2017 Jul 31;12(7):e0182202. doi: 10.1371/journal.pone.0182202. eCollection 2017.
Metabolic bone disorders frequently occur in patients with chronic liver disease; however, the association between liver fibrosis and bone mineral density in patients with non-alcoholic fatty liver disease (NAFLD) is unclear.
This is a cross-sectional analysis of 231 asymptomatic subjects (160 women, 61.6 years old) from a university hospital setting, between February 2012 and December 2014. Bone mineral density (BMD) was measured at the lumbar spine, femur neck, and total hip using dual-energy X-ray absorptiometry (DXA). Liver fibrosis and steatosis were assessed using transient elastography.
Among a total of 231 individuals, 129 subjects (55.8%) had NAFLD. BMDs at lumbar spine, femur neck, and total hip were significantly lower in patients having NAFLD with significant fibrosis, compared with patients having NAFLD without significant fibrosis (Ps<0.005). In patients with NAFLD, significant liver fibrosis revealed marked negative correlations with BMD at the lumber spine (r = -0.19, P = 0.032), femur neck (r = -0.19, P = 0.034), and total hip (r = -0.21, P = 0.016). A multivariate linear regression analysis revealed that significant liver fibrosis was independently correlated with low BMD at the femur neck (β = -0.18, P = 0.039) and total hip (β = -0.21, P = 0.005) after adjustment for age, sex, BMI, fasting plasma glucose, alanine aminotransferase, high-density lipoprotein cholesterol, and liver steatosis among patients with NAFLD. Using multivariable logistic regression, significant liver fibrosis was independently associated with overall osteopenia and osteoporosis in subjects having NAFLD (OR = 4.10, 95% CI = 1.02-16.45).
The presence of significant liver fibrosis assessed via TE was independently associated with low BMD in NAFLD subjects.
代谢性骨病在慢性肝病患者中经常发生；然而，非酒精性脂肪性肝病（NAFLD）患者中肝纤维化与骨密度之间的关联尚不清楚。
这是一项对2012年2月至2014年12月期间来自某大学医院的231名无症状受试者（160名女性，61.6岁）进行的横断面分析。使用双能X线吸收法（DXA）测量腰椎、股骨颈和全髋部的骨密度（BMD）。使用瞬时弹性成像评估肝纤维化和脂肪变性。
在总共231名个体中，129名受试者（55.8%）患有NAFLD。与无显著纤维化的NAFLD患者相比，有显著纤维化的NAFLD患者的腰椎、股骨颈和全髋部的骨密度显著降低（P<0.005）。在NAFLD患者中，显著的肝纤维化与腰椎（r = -0.19，P = 0.032）、股骨颈（r = -0.19，P = 0.034）和全髋部（r = -0.21，P = 0.016）的骨密度呈显著负相关。多变量线性回归分析显示，在对NAFLD患者的年龄、性别、体重指数、空腹血糖、丙氨酸转氨酶、高密度脂蛋白胆固醇和肝脂肪变性进行调整后，显著的肝纤维化与股骨颈（β = -0.18，P = 0.039）和全髋部（β = -0.21，P = 0.005）的低骨密度独立相关。使用多变量逻辑回归分析，显著的肝纤维化与NAFLD受试者的总体骨质减少和骨质疏松独立相关（OR = 4.10，95%CI = 1.02 - 16.45）。
通过TE评估的显著肝纤维化的存在与NAFLD受试者的低骨密度独立相关。
