Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea.
Am J Gastroenterol. 2019 Apr;114(4):620-629. doi: 10.14309/ajg.0000000000000074.
We compared liver-related mortality by fibrosis severity between 2 types of fatty liver disease (FLD), nonalcoholic FLD (NAFLD) and alcoholic FLD (AFLD), in a large cohort of nonobese and obese individuals.
A cohort study was performed with 437,828 Korean adults who were followed up for up to 14 years. Steatosis was diagnosed based on ultrasonography; fibrosis severity was determined by the fibrosis 4 (FIB-4) score. Vital status and liver-related deaths were ascertained through linkage to national death records.
The prevalence of NAFLD and AFLD was 20.9% and 4.0%, respectively. During 3,145,541.1 person-years of follow-up, 109 liver-related deaths were identified (incidence rate of 3.5 per 10 person-years). When changes in fatty liver status, FIB-4 scores, and confounders during follow-up were updated as time-varying covariates, compared with the reference (absence of both excessive alcohol use and FLD), the multivariable-adjusted hazard ratios with 95% confidence intervals for liver-related mortality among those with low, intermediate, and high FIB-4 scores were 0.43 (0.19-0.94), 2.74 (1.23-6.06), and 84.66 (39.05-183.54), respectively, among patients with NAFLD, whereas among patients with AFLD, the corresponding hazard ratios (95% confidence intervals) were 0.67 (0.20-2.25), 5.44 (2.19-13.49), and 59.73 (27.99-127.46), respectively. The associations were more evident in nonobese individuals than in obese individuals (P for interaction = 0.004).
In this large cohort of young and middle-aged individuals, NAFLD and AFLD with intermediate to high fibrosis scores were associated with an increased risk of liver-related mortality in a dose-dependent manner, especially among nonobese individuals.
我们比较了非酒精性脂肪肝（NAFLD）和酒精性脂肪肝（AFLD）这两种脂肪肝疾病在非肥胖和肥胖个体中，按纤维化严重程度划分的肝相关死亡率。
对 437828 名韩国成年人进行了一项队列研究，随访时间长达 14 年。通过超声诊断肝脂肪变性；纤维化严重程度通过纤维化 4 （FIB-4）评分确定。通过与国家死亡记录的链接确定生存状态和与肝脏相关的死亡。
NAFLD 和 AFLD 的患病率分别为 20.9%和 4.0%。在 3145541.1 人年的随访期间，共发现 109 例与肝脏相关的死亡（发病率为 3.5/10 人年）。当随访期间肝脂肪变性状态、FIB-4 评分和混杂因素的变化作为时变协变量更新时，与参考组（既无过量饮酒也无脂肪肝）相比，NAFLD 患者中低、中、高 FIB-4 评分组的多变量校正后的肝相关死亡率的风险比（95%置信区间）分别为 0.43（0.19-0.94）、2.74（1.23-6.06）和 84.66（39.05-183.54），而 AFLD 患者的相应风险比（95%置信区间）分别为 0.67（0.20-2.25）、5.44（2.19-13.49）和 59.73（27.99-127.46）。这种关联在非肥胖个体中比在肥胖个体中更为明显（P 交互=0.004）。
在这项针对年轻和中年个体的大型队列研究中，NAFLD 和 AFLD 伴中至高度纤维化与肝相关死亡率呈剂量依赖性增加，尤其是在非肥胖个体中。
