Hagström Hannes, Nasr Patrik, Ekstedt Mattias, Hammar Ulf, Stål Per, Hultcrantz Rolf, Kechagias Stergios
Center for Digestive Diseases, Division of Hepatology Karolinska University Hospital Stockholm Sweden.
Department of Medicine, Huddinge Karolinska Institute Stockholm Sweden.
Hepatol Commun. 2017 Nov 30;2(1):48-57. doi: 10.1002/hep4.1124. eCollection 2018 Jan.
Most patients with nonalcoholic fatty liver disease (NAFLD) are overweight or obese. However, a significant proportion of patients have a normal body mass index (BMI), denoted as lean NAFLD. The long-term prognosis of lean NAFLD is unclear. We conducted a cohort study of 646 patients with biopsy-proven NAFLD. Patients were defined as lean (BMI < 25.0), overweight (BMI 25.0-29.9), or obese (BMI ≥ 30.0) at the time of biopsy. Each case was matched for age, sex, and municipality to 10 controls. Overall mortality and development of severe liver disease were evaluated using population-based registers. Cox regression models adjusted for age, sex, type 2 diabetes, and fibrosis stage were used to examine the long-term risk of mortality and liver-related events in lean and nonlean NAFLD. Lean NAFLD was seen in 19% of patients, while 52% were overweight and 29% were obese. Patients with lean NAFLD were older, had lower transaminases, lower stages of fibrosis, and lower prevalence of nonalcoholic steatohepatitis at baseline compared to patients with a higher BMI. During a mean follow-up of 19.9 years (range 0.4-40 years) representing 12,631 person years and compared to patients who were overweight, patients with lean NAFLD had no increased risk for overall mortality (hazard ratio 1.06; 0.73) while an increased risk for development of severe liver disease was found (hazard ratio 2.69; 0.007). : Although patients with lean NAFLD have lower stages of fibrosis, they are at higher risk for development of severe liver disease compared to patients with NAFLD and a higher BMI, independent of available confounders. ( 2018;2:48-57).
大多数非酒精性脂肪性肝病（NAFLD）患者超重或肥胖。然而，相当一部分患者的体重指数（BMI）正常，即 lean NAFLD。lean NAFLD 的长期预后尚不清楚。我们对 646 例经活检证实为 NAFLD 的患者进行了一项队列研究。在活检时，患者被定义为 lean（BMI＜25.0）、超重（BMI 25.0 - 29.9）或肥胖（BMI≥30.0）。每个病例按年龄、性别和直辖市与 10 名对照进行匹配。使用基于人群的登记系统评估总死亡率和严重肝病的发生情况。采用校正年龄、性别、2 型糖尿病和纤维化分期的 Cox 回归模型来研究 lean 和非 lean NAFLD 患者的长期死亡风险和肝脏相关事件。19%的患者为 lean NAFLD，52%为超重，29%为肥胖。与 BMI 较高的患者相比，lean NAFLD 患者年龄更大，基线时转氨酶更低，纤维化分期更低，非酒精性脂肪性肝炎的患病率更低。在平均 19.9 年（范围 0.4 - 40 年）的随访期内，代表 12631 人年，与超重患者相比，lean NAFLD 患者的总死亡率没有增加（风险比 1.06；95%置信区间 0.73），但发现严重肝病的发生风险增加（风险比 2.69；95%置信区间 1.42 - 5.07；P = 0.007）。尽管 lean NAFLD 患者的纤维化分期较低，但与 NAFLD 且 BMI 较高的患者相比，他们发生严重肝病的风险更高，且不受现有混杂因素的影响。（2018；2：48 - 57）
