非酒精性脂肪性肝病的临床转归：波兰病例对照研究。

Clinical outcomes of non-alcoholic fatty liver disease: Polish-case control study.

机构信息

Department of Gastroenterology and Hepatology, Wroclaw Medical University, Poland.

Gastroenterology Student Organization, Wroclaw Medical University, Poland.

出版信息

Adv Clin Exp Med. 2019 Dec;28(12):1615-1620. doi: 10.17219/acem/106173.

DOI:10.17219/acem/106173

PMID:31025557

Abstract

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is becoming the most common cause of chronic liver disease worldwide, affecting up to 30% of population. Non-alcoholic fatty liver disease can lead to non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and hepatocellular carcinoma. Age, obesity, insulin resistance, type 2 diabetes, and dyslipidemia are important risk factors for developing hepatic steatosis. Concomitant diseases, especially cardiovascular, are discussed as important causes of death in NAFLD patients.

OBJECTIVES

The objective of this study was to conduct a retrospective comparison of the frequency of concomitant diseases in NAFLD patients and controls, especially metabolic syndrome and cardiovascular disease (CVD).

MATERIAL AND METHODS

A total of 1,058 (558 NAFLD patients and 500 controls). Diagnosis of NAFLD was established with ultrasound examination in the absence of other causes of fatty liver. The control group included patients with no history of liver disease, normal liver image in ultrasound examination and normal liver laboratory tests.

RESULTS

Overweight and/or obesity were diagnosed in 80.8% of patients in the study group and 40.8% in the controls (p < 0.001). Metabolic syndrome was present in 48.7% patients in the study group compared with 14.4% controls, (p < 0.001). In the study group, we found higher prevalence of hypertension (56.1% vs 37%; p < 0.001), type 2 diabetes mellitus (24.4% vs 8.6%; p < 0.001), decreased concentration of serum HDL (35.1% vs 19.5%; p < 0.001), elevated serum triglycerides (36.5% vs 15.4%; p < 0.001). Cardiovascular disease was found in 13.6% of individuals in the study group and in 15% controls (NS, p = 0.32). The most frequent concomitant gastrointestinal disease present in the study group was gastroesophageal reflux disease (GERD) (31.9% vs 22.8%; p < 0.001) followed by colonic diverticulosis (23.7% vs 15.8%; p < 0.005).

CONCLUSIONS

Metabolic syndrome with its components is more common in NAFLD patients compared to matched controls. Additionally, NAFLD patients are more often affected by GERD and colonic diverticulosis but not by CVD.

摘要

背景

非酒精性脂肪性肝病（NAFLD）正成为全球最常见的慢性肝病病因，影响多达 30%的人群。非酒精性脂肪性肝病可导致非酒精性脂肪性肝炎（NASH）、纤维化、肝硬化和肝细胞癌。年龄、肥胖、胰岛素抵抗、2 型糖尿病和血脂异常是非酒精性脂肪性肝病患者发生肝脂肪变性的重要危险因素。合并症，特别是心血管疾病，被认为是 NAFLD 患者死亡的重要原因。

目的

本研究旨在对 NAFLD 患者和对照组合并症的频率进行回顾性比较，特别是代谢综合征和心血管疾病（CVD）。

材料和方法

共纳入 1058 例患者（558 例 NAFLD 患者和 500 例对照组）。NAFLD 的诊断采用超声检查在无其他原因导致脂肪肝的情况下确立。对照组包括无肝脏疾病史、超声检查肝脏图像正常和肝脏实验室检查正常的患者。

结果

研究组中 80.8%的患者超重或肥胖，对照组中 40.8%（p < 0.001）。研究组中代谢综合征的发生率为 48.7%，对照组为 14.4%（p < 0.001）。在研究组中，我们发现高血压（56.1% vs 37%；p < 0.001）、2 型糖尿病（24.4% vs 8.6%；p < 0.001）、血清高密度脂蛋白浓度降低（35.1% vs 19.5%；p < 0.001）、血清甘油三酯升高（36.5% vs 15.4%；p < 0.001）的发生率较高。研究组中有 13.6%的患者患有心血管疾病，对照组中有 15%的患者（NS，p = 0.32）。研究组中最常见的胃肠道合并疾病是胃食管反流病（GERD）（31.9% vs 22.8%；p < 0.001），其次是结肠憩室病（23.7% vs 15.8%；p < 0.005）。