Tanaka Kenichi, Takahashi Hirokazu, Hyogo Hideyuki, Ono Masafumi, Oza Noriko, Kitajima Yoichiro, Kawanaka Miwa, Chayama Kazuaki, Saibara Toshiji, Anzai Keizo, Eguchi Yuichiro
Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga, Japan.
Clinical Gastroenterology, Eguchi Hospital, Saga, Japan.
Hepatol Res. 2019 Mar;49(3):296-303. doi: 10.1111/hepr.13282. Epub 2018 Nov 28.
The association between glycemia and liver fibrosis was analyzed using hemoglobin A1c (HbA1c) and the Fibrosis-4 (FIB-4) index in a large general population cohort that underwent a health checkup.
A total of 6927 subjects without hepatitis B or C virus infection or habitual alcohol intake were enrolled. Non-alcoholic fatty liver disease (NAFLD) was diagnosed by ultrasonography and potential liver fibrosis (FIB-4 index ≥1.3) in NAFLD was analyzed in relation to HbA1c level. Factors associated with potential liver fibrosis of NAFLD were also analyzed.
The overall frequency of NAFLD was 27.9% (1935 subjects) and the frequency of NAFLD by HbA1c level (<4.9%, 5.0-5.9%, 6.0-6.9%, 7.0-7.9%, ≥8.0%) was 16%, 27%, 54%, 53%, and 54%, respectively. Among the 1935 NAFLD cases, the frequency of potential liver fibrosis was 25.2% (487 subjects) overall and 19%, 22%, 30%, 52%, and 31%, respectively, by HbA1c category. From multivariate analysis, an HbA1c level ≥6.5% was significantly associated with potential liver fibrosis (P = 0.017, hazard ratio = 1.7).
The prevalence of NAFLD and liver fibrosis of NAFLD increased according to glycemia, up to 8.0% HbA1c. Measuring HbA1c and calculating the FIB-4 index in health checkups could help to identify potential cases of liver fibrosis of NAFLD, which should then be further evaluated using other techniques to confirm liver fibrosis.
在接受健康检查的大型普通人群队列中，使用糖化血红蛋白（HbA1c）和纤维化-4（FIB-4）指数分析血糖与肝纤维化之间的关联。
共纳入6927名无乙型或丙型肝炎病毒感染或习惯性饮酒的受试者。通过超声诊断非酒精性脂肪性肝病（NAFLD），并分析NAFLD中潜在肝纤维化（FIB-4指数≥1.3）与HbA1c水平的关系。还分析了与NAFLD潜在肝纤维化相关的因素。
NAFLD的总体发生率为27.9%（1935名受试者），按HbA1c水平（<4.9%、5.0-5.9%、6.0-6.9%、7.0-7.9%、≥8.0%）划分的NAFLD发生率分别为16%、27%、54%、53%和54%。在1935例NAFLD病例中，潜在肝纤维化的总体发生率为25.2%（487名受试者），按HbA1c类别划分分别为19%、22%、30%、52%和31%。多因素分析显示，HbA1c水平≥6.5%与潜在肝纤维化显著相关（P = 0.017，风险比 = 1.7）。
NAFLD及NAFLD肝纤维化的患病率随血糖升高而增加，直至HbA1c达到8.0%。在健康检查中检测HbA1c并计算FIB-4指数有助于识别NAFLD潜在肝纤维化病例，然后应使用其他技术进一步评估以确认肝纤维化。
