Tada Toshifumi, Kumada Takashi, Toyoda Hidenori, Mizuno Kazuyuki, Sone Yasuhiro, Akita Tomoyuki, Tanaka Junko
Department of Gastroenterology and Hepatology Ogaki Municipal Hospital Ogaki Japan.
Department of Radiology Ogaki Municipal Hospital Ogaki Japan.
Hepatol Commun. 2017 Sep 26;1(9):899-910. doi: 10.1002/hep4.1105. eCollection 2017 Nov.
In patients with nonalcoholic fatty liver disease (NAFLD), prognosis and outcome, especially non-liver-related mortality, remain incompletely elucidated. We clarified the mortality from all causes in patients with NAFLD. A total of 4,073 patients with NAFLD diagnosed by ultrasonography were enrolled. We investigated the causes of death and analyzed the mortality from non-liver-related diseases according to the degrees of steatosis and fibrosis using the competing risk method. We used the NAFLD fibrosis score (NFS) to assess fibrosis severity and the ultrasonography fatty liver score to evaluate steatosis severity. The numbers of patients with NFS indicating low, intermediate, and high probabilities of advanced fibrosis were 2,451 (60.2%), 1,462 (35.9%), and 160 (3.9%), respectively. Of the 4,073 patients, 179 died during follow-up, but only nine deaths were due to liver-related diseases. Of the remaining 170 patients who died due to non-liver-related diseases, 83 (48.8%), 42 (24.7%), and 45 (26.5%) patients died due to malignancies, cerebrovascular and cardiovascular diseases, and benign diseases (excluding cerebrovascular and cardiovascular diseases), respectively. Multivariate analysis showed that the intermediate and high NFS groups were independently associated with each disease category: hazard ratio (HR) 2.163 (95% confidence interval [CI], 1.354-3.457) and HR 4.814 (95% CI, 2.323-9.977) for malignancies; HR 2.265 (95% CI, 1.141-4.497) and HR 8.482 (95% CI, 3.558-20.220) for cerebrovascular and cardiovascular diseases; and HR 3.216 (95% CI, 1.641-6.303) and HR 5.558 (95% CI, 1.923-16.070) for benign diseases, respectively. Conversely, the status of steatosis was not associated with risk of mortality in multivariate analysis. : Progression of liver fibrosis severity was associated with mortality from various non-liver-related causes in patients with NAFLD. ( 2017;1:928-945).
在非酒精性脂肪性肝病（NAFLD）患者中，其预后及结局，尤其是与肝脏无关的死亡率，仍未完全阐明。我们明确了NAFLD患者的全因死亡率。共纳入4073例经超声诊断为NAFLD的患者。我们调查了死亡原因，并使用竞争风险法根据脂肪变性和纤维化程度分析了非肝脏相关疾病的死亡率。我们使用NAFLD纤维化评分（NFS）评估纤维化严重程度，使用超声脂肪肝评分评估脂肪变性严重程度。NFS提示晚期纤维化低、中、高概率的患者数量分别为2451例（60.2%）、1462例（35.9%）和160例（3.9%）。在4073例患者中，179例在随访期间死亡，但只有9例死亡是由于肝脏相关疾病。在其余170例因非肝脏相关疾病死亡的患者中，分别有83例（48.8%）、42例（24.7%）和45例（26.5%）死于恶性肿瘤、脑血管和心血管疾病以及良性疾病（不包括脑血管和心血管疾病）。多因素分析显示，NFS中、高分组与各疾病类别独立相关：恶性肿瘤的风险比（HR）为分别为为2.163（95%置信区间[CI]，1.354 - 3.457）和4.814（95%CI，2.323 - 9.977）；脑血管和心血管疾病的HR分别为2.265（95%CI，1.141 - 4.497）和8.482（95%CI，3.558 - 20.220）；良性疾病的HR分别为3.216（95%CI，1.641 - 6.303）和5.558（95%CI，1.923 - 16.070）。相反，在多因素分析中，脂肪变性状态与死亡风险无关。NAFLD患者肝脏纤维化严重程度的进展与各种非肝脏相关原因导致的死亡率相关。（2017；1：928 - 945）
