Primary Health Care Center, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro.
Department of Health Sciences, University Magna Graecia, Catanzaro, Italy -
Minerva Med. 2019 Jun;110(3):191-198. doi: 10.23736/S0026-4806.19.05978-0. Epub 2019 Feb 14.
It is known that non-alcoholic fatty liver disease (NAFLD), and in particular non-alcoholic steatohepatitis, can progress to advanced fibrosis. However, pathophysiological mechanisms implicated in this evolution are not elucidated yet. We aimed to investigate the independent predictors of liver fibrosis in patients with NAFLD, determined by BARD score, one of the most used algorithms for fibrosis evaluation.
This prospective study enrolled a total of 301 participants with NAFLD, as determined by a Fatty Liver Index (FLI) ≥60. All patients were categorized into two groups: with no/mild fibrosis (BARD score 1, N.=62) and with advanced fibrosis (BARD score 2, 3 and 4 N.=239).
Serum high density lipoprotein cholesterol (HDL-c), glucose and glycated hemoglobin were higher (P=0.028, P<0.001 and P=0.002, respectively), whereas serum transaminases and gamma glutamil transferase levels were lower in patients with advanced fibrosis than in those with no/mild fibrosis (P=0.010, P<0.001 and P=0.005, respectively). There were no significant differences in oxidative stress (i.e., advanced oxidant protein products and malondialdehyde) and anti-oxidative protection markers (i.e., catalase) between patients with no/mild fibrosis and advanced fibrosis. Multivariate ordinal regression analysis showed independent associations and predictions of ages (OR=1.071, 95% CI 1.004-1.097, P<0.001), and HDL-c levels (OR=2.549, 95% CI 1.087-5.989, P=0.032) on BARD score categories in patients with NAFLD.
In conclusion, we found that older age and higher HDL-c, are independent predictors for advanced liver fibrosis assessed with the BARD score. Future investigations are needed to further explore this relationship.
非酒精性脂肪性肝病（NAFLD），特别是非酒精性脂肪性肝炎，可进展为晚期纤维化。然而，与这种演变相关的病理生理机制尚未阐明。我们旨在通过 BARD 评分（评估纤维化最常用的算法之一）研究 NAFLD 患者纤维化的独立预测因子。
这项前瞻性研究共纳入 301 名 NAFLD 患者，其脂肪性肝病指数（FLI）≥60。所有患者分为两组：无/轻度纤维化（BARD 评分 1，N.=62）和晚期纤维化（BARD 评分 2、3 和 4，N.=239）。
血清高密度脂蛋白胆固醇（HDL-c）、葡萄糖和糖化血红蛋白水平较高（P=0.028、P<0.001 和 P=0.002），而血清转氨酶和γ谷氨酰转移酶水平在晚期纤维化患者中较低（P=0.010、P<0.001 和 P=0.005）。无/轻度纤维化和晚期纤维化患者之间的氧化应激（即，高级氧化蛋白产物和丙二醛）和抗氧化保护标志物（即，过氧化氢酶）无显著差异。多变量有序回归分析显示年龄（OR=1.071，95%CI 1.004-1.097，P<0.001）和 HDL-c 水平（OR=2.549，95%CI 1.087-5.989，P=0.032）与 NAFLD 患者 BARD 评分类别独立相关和预测。
总之，我们发现年龄较大和 HDL-c 较高是 BARD 评分评估的晚期肝纤维化的独立预测因子。需要进一步研究以进一步探讨这种关系。
