Department of Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
Interdisciplinary Center for Clinical Trials (IZKS), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
Aliment Pharmacol Ther. 2018 Nov;48(10):1109-1116. doi: 10.1111/apt.14976. Epub 2018 Oct 4.
Advanced fibrosis has been established as the most important predictor of overall mortality in patients with non-alcoholic fatty liver disease (NAFLD). In contrast to cirrhosis, advanced, non-cirrhotic NAFLD is difficult to identify and data from Germany are lacking.
To identify clinical factors associated with advanced, non-cirrhotic fibrosis.
Patients were recruited in the prospectively enrolling European NAFLD Registry. Clinical characteristics and the performance of non-invasive surrogate scores compared with vibration-controlled transient elastography are reported.
Two hundred and sixty-one patients with non-cirrhotic NAFLD on liver biopsy (mean age 51 years, equal sex distribution) were included. The prevalence of stage 3 fibrosis on liver biopsy was 15.7%. These patients were significantly older (57 vs 50 years, P < 0.01), had a higher body mass index (32.3 vs 30.5, P < 0.05), and more frequent arterial hypertension (78% vs 50%, P = 0.001) and type 2 diabetes (61% vs 24.1%, P < 0.001). On multivariate logistic regression, diabetes (OR = 4.68, 95% CI 2.17-10.10) and hypertension (OR = 2.91, 95% CI 1.12-7.18) were independent predictors of advanced fibrosis. Comedication included metformin in 50% and insulin in 33% of patients with diabetes. Despite the presence of cardiovascular risk factors, the use of statins was low. Liver stiffness measurement identified advanced fibrosis with an AUROC of 0.81 (95% CI 0.72-0.91). The performance of NAFLD fibrosis score, Fibrosis-4, and AST to platelet ratio index were lower with AUCs of 0.74, 0.71, and 0.67, respectively.
The prevalence of metabolic comorbidities in a German population with non-cirrhotic biopsy-proven NAFLD is high. While the examined scores exhibit an acceptable specificity, liver stiffness measurement appeared to be superior to blood-based non-invasive surrogate scores in ruling out advanced fibrosis.
纤维化程度是预测非酒精性脂肪性肝病（NAFLD）患者总死亡率的最重要指标。与肝硬化不同，进展性、非肝硬化性 NAFLD 较难识别，且德国缺乏相关数据。
确定与进展性、非肝硬化性纤维化相关的临床因素。
前瞻性纳入欧洲 NAFLD 注册研究中的患者。报告了临床特征和各种非侵入性替代评分与受控衰减参数（CAP）的比较。
261 例经肝活检证实的非肝硬化性 NAFLD 患者（平均年龄 51 岁，男女各占一半）纳入研究。肝活检纤维化分期 3 期的患病率为 15.7%。这些患者年龄明显较大（57 岁比 50 岁，P<0.01），体质指数（BMI）更高（32.3 比 30.5，P<0.05），更常合并高血压（78%比 50%，P=0.001）和 2 型糖尿病（61%比 24.1%，P<0.001）。多变量逻辑回归分析显示，糖尿病（OR=4.68，95%CI 2.17-10.10）和高血压（OR=2.91，95%CI 1.12-7.18）是进展性纤维化的独立预测因素。合并糖尿病的患者中，50%服用二甲双胍，33%服用胰岛素。尽管存在心血管危险因素，但他汀类药物的使用率较低。CAP 检测进展性纤维化的 AUROC 为 0.81（95%CI 0.72-0.91）。NAFLD 纤维化评分、纤维化-4 指数和天冬氨酸氨基转移酶/血小板比值指数的 AUC 分别为 0.74、0.71 和 0.67，性能较低。
德国经肝活检证实的非肝硬化性 NAFLD 患者合并代谢性合并症的比例较高。在特异性方面，所检查的评分具有可接受性，而 CAP 似乎优于基于血液的非侵入性替代评分，可用于排除进展性纤维化。
