Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Internal Medicine, Healthcare System Gangnam Center, Healthcare Research Institute, Seoul National University Hospital, Seoul, Korea.
Liver Int. 2018 Nov;38(11):2091-2100. doi: 10.1111/liv.13860. Epub 2018 May 3.
BACKGROUND & AIMS: The association between nonalcoholic fatty liver disease and lung function has not been fully examined. The aim of this study was to clarify the association between nonalcoholic fatty liver disease and lung function in general population by performing cross-sectional and longitudinal analysis.
Participants without hepatic and respiratory disease who underwent regular health exams including hepatic sonography and spirometry with at least 3 years' follow-up were included. In cross-sectional analysis, the association between nonalcoholic fatty liver disease and lung function at baseline was examined with multiple regression models. The longitudinal analysis was performed by mixed linear regression models with propensity score matching.
Of 11 892 eligible participants (mean age, 47.7 years; male, 47.2%), 3815(32.1%) had nonalcoholic fatty liver disease based on sonography. In cross-sectional analysis, the nonalcoholic fatty liver disease group had lower adjusted forced expiratory volume in 1-second (men, 3.52 vs 3.44 L, P < .001; women, 2.62 vs 2.45 L, P < .001) and forced vital capacity (men, 4.33 vs 4.24 L, P < .001; women, 3.11 vs 2.97 L, P < .001) than the control group. In longitudinal analysis, during the mean follow-up period of 6.6 years, there were no significant differences in forced expiratory volume in 1-second or forced vital capacity decline rates between two groups in the propensity score-matched cohorts (n = 4558). However, those with high nonalcoholic fatty liver disease fibrosis score and fibrosis-4 (men, -21.7 vs -27.4 mL/y, P = .001; women, -22.4 vs -27.9 mL/y, P = .016) showed significantly faster decline in forced vital capacity compared to those with low scores.
Nonalcoholic fatty liver disease was associated with decreased lung function at baseline but was not associated with accelerated lung function decline in the propensity score-matched cohort. However, hepatic fibrosis was significantly associated with rapid forced vital capacity decline.
非酒精性脂肪性肝病与肺功能之间的关系尚未得到充分研究。本研究旨在通过横断面和纵向分析，阐明一般人群中非酒精性脂肪性肝病与肺功能之间的关系。
纳入无肝、呼吸系统疾病且至少进行过 3 年随访的人群，进行常规体检，包括肝脏超声和肺功能检查。在横断面分析中，采用多元回归模型，研究基线时非酒精性脂肪性肝病与肺功能之间的关系。采用倾向评分匹配的混合线性回归模型进行纵向分析。
在 11892 名符合条件的参与者中（平均年龄为 47.7 岁，男性占 47.2%），3815 名（32.1%）根据超声检查结果诊断为非酒精性脂肪性肝病。在横断面分析中，非酒精性脂肪性肝病组调整后的 1 秒用力呼气量（男性，3.52 升比 3.44 升，P<0.001；女性，2.62 升比 2.45 升，P<0.001）和用力肺活量（男性，4.33 升比 4.24 升，P<0.001；女性，3.11 升比 2.97 升，P<0.001）均低于对照组。在纵向分析中，在平均 6.6 年的随访期间，在倾向评分匹配队列中（n=4558），两组的 1 秒用力呼气量或用力肺活量下降率无显著差异。然而，纤维化评分和纤维化-4 较高的非酒精性脂肪性肝病患者（男性，-21.7 毫升/年比-27.4 毫升/年，P=0.001；女性，-22.4 毫升/年比-27.9 毫升/年，P=0.016）的用力肺活量下降速度明显快于评分较低的患者。
非酒精性脂肪性肝病与基线时肺功能下降有关，但在倾向评分匹配队列中与肺功能下降加速无关。然而，肝纤维化与用力肺活量的快速下降显著相关。
