Division of Gastroenterology and Hepatology, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA.
Department of Medicine, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10021, USA.
Dig Dis Sci. 2019 Jan;64(1):262-268. doi: 10.1007/s10620-018-5295-x. Epub 2018 Sep 29.
Nonalcoholic fatty pancreas disease (NAF-P) is strongly linked with nonalcoholic fatty liver disease (NAFLD), but its relationship with advanced liver disease is unknown.
This study investigated the association between NAF-P and both advanced fibrosis and nonalcoholic steatohepatitis (NASH).
This retrospective study evaluated adults with biopsy-proven NAFLD with a sonogram within 1 year of liver biopsy. NAF-P was diagnosed by comparing the echogenicity of the pancreas to the kidney and was graded by severity. The primary outcome was the effect of NAF-P on the presence of advanced fibrosis and NASH, while secondary outcomes included the association of extensive NAF-P (grade II/III). Propensity score matching for independent risk factors of advanced fibrosis (age, gender, body mass index, and diabetes) was performed.
One hundred and four patients were included in the study and 91 (87.5%) had NAF-P. After propensity score matching, NAF-P was significantly associated with advanced fibrosis (OR 10.52, p < 0.001) but not NASH (p = 0.27). Extensive NAF-P was predictive of advanced fibrosis (OR 3.35, p = 0.006) and NASH (OR 5.37, p < 0.001). NAF-P had a negative predictive value (NPV) of 93% for advanced fibrosis. When matching for the NAFLD fibrosis score in addition to the variables above, both NAF-P (OR 5.36, p = 0.001) and extensive NAF-P (OR 5.38, p = 0.002) still significantly predicted advanced fibrosis.
NAF-P is predictive of advanced fibrosis, even when controlling for independent predictors of advanced fibrosis and the NAFLD fibrosis score. NAF-P has an excellent NPV and is a safe, inexpensive finding that can rule out advanced fibrosis.
非酒精性脂肪性胰腺疾病（NAF-P）与非酒精性脂肪性肝病（NAFLD）密切相关，但与晚期肝病的关系尚不清楚。
本研究旨在探讨 NAF-P 与肝纤维化和非酒精性脂肪性肝炎（NASH）的相关性。
本回顾性研究评估了在肝活检前 1 年内进行过超声检查且活检证实为 NAFLD 的成年人。通过比较胰腺与肾脏的回声强度来诊断 NAF-P，并按严重程度进行分级。主要结局是 NAF-P 对晚期纤维化和 NASH 存在的影响，次要结局包括广泛 NAF-P（Ⅱ/Ⅲ级）的相关性。对晚期纤维化的独立危险因素（年龄、性别、体重指数和糖尿病）进行倾向评分匹配。
共有 104 例患者纳入研究，91 例（87.5%）患有 NAF-P。在倾向评分匹配后，NAF-P 与晚期纤维化显著相关（OR 10.52，p<0.001），但与 NASH 无关（p=0.27）。广泛的 NAF-P 预测晚期纤维化（OR 3.35，p=0.006）和 NASH（OR 5.37，p<0.001）。NAF-P 对晚期纤维化的阴性预测值（NPV）为 93%。当在上述变量的基础上，再加上 NAFLD 纤维化评分进行匹配时，NAF-P（OR 5.36，p=0.001）和广泛的 NAF-P（OR 5.38，p=0.002）仍然显著预测晚期纤维化。
即使控制晚期纤维化的独立预测因素和 NAFLD 纤维化评分，NAF-P 仍可预测晚期纤维化。NAF-P 的 NPV 较好，是一种安全、廉价的发现，可以排除晚期纤维化。
