Division of Gastroenterology and Hepatology, Alameda Health System-Highland Hospital, Oakland, CA, United States of America.
Gilead Sciences, Foster City, CA, United States of America.
PLoS One. 2019 Aug 1;14(8):e0220612. doi: 10.1371/journal.pone.0220612. eCollection 2019.
Hepatic fibrosis and advanced fibrosis in particular is the strongest predictor of liver-related outcomes and mortality among nonalcoholic steatohepatitis (NASH) patients. Understanding prevalence and predictors of NASH with advanced fibrosis is critical for healthcare resource planning. Using a large U.S. clinical laboratory database from 10/1/2017-9/30/2018, adults negative for hepatitis B and hepatitis C and after excluding for alcoholic liver disease and pregnancy were evaluated for prevalence of F3 and F4 fibrosis using a systematic algorithm of five fibrosis-4 (FIB-4) criteria: Criteria 1 (≥F3: >2.67), Criteria 2 (2.67<F3≤4.12 and F4>4.12), Criteria 3 (2.67<F3≤3.15, F4>3.15), Criteria 4 (3.25<F3≤3.5, F4>3.5), Criteria 5 (3.25<F3≤4.12, F4>4.12). Metabolic co-morbidities evaluated included decreased high density lipoprotein (<40 mg/dL men, <50 mg/dL women), high triglycerides (≥150 mg/dL), elevated hemoglobin A1C (≥6.5%). Parallel analyses of patients with specific NAFLD/NASH ICD-9/10 codes from 10/1/2013-9/30/2018 were performed. Multivariate logistic regression models evaluated for predictors of ≥F3 fibrosis. Among patients with NAFLD/NASH ICD-9/10 codes, ≥F3 prevalence ranged from 4.35% - 6.90%, and F4 prevalence ranged from 2.52%- 3.67%. Increasing metabolic co-morbidities was associated with higher risk of ≥F3 fibrosis. Compared to NASH patients without metabolic co-morbidities, NASH with four concurrent metabolic co-morbidities had higher risk of ≥F3 (OR 1.56, 95% CI 1.40-1.73, p<0.001). In summary, prevalence of NASH with advanced fibrosis among U.S. adults was as high as 6.90% and prevalence of NASH with cirrhosis was as high as 3.67%, representing 5.18 million and 2.75 million, respectively, when using an estimate of 75 million U.S. adults with NAFLD. Co-morbid metabolic abnormalities were associated with higher risk of advanced fibrosis among NASH patients.
肝纤维化，尤其是晚期纤维化，是导致非酒精性脂肪性肝炎（NASH）患者发生肝脏相关结局和死亡的最强预测因子。了解 NASH 伴晚期纤维化的流行率和预测因素对于医疗资源规划至关重要。本研究利用美国一家大型临床实验室数据库，纳入 2017 年 10 月 1 日至 2018 年 9 月 30 日期间乙型肝炎和丙型肝炎阴性、排除酒精性肝病和妊娠的成年人，采用五个纤维化-4（FIB-4）标准的系统算法评估 F3 和 F4 纤维化的流行率：标准 1（≥F3：>2.67）、标准 2（2.67<F3≤4.12 和 F4>4.12）、标准 3（2.67<F3≤3.15，F4>3.15）、标准 4（3.25<F3≤3.5，F4>3.5）、标准 5（3.25<F3≤4.12，F4>4.12）。评估的代谢合并症包括高密度脂蛋白降低（男性<40mg/dL，女性<50mg/dL）、甘油三酯升高（≥150mg/dL）、糖化血红蛋白升高（≥6.5%）。对 2013 年 10 月 1 日至 2018 年 9 月 30 日期间特定 NASH/NAFLD ICD-9/10 编码的患者进行了平行分析。多变量逻辑回归模型评估了≥F3 纤维化的预测因子。在患有 NASH/NAFLD ICD-9/10 编码的患者中，≥F3 的患病率为 4.35%-6.90%，F4 的患病率为 2.52%-3.67%。代谢合并症的增加与≥F3 纤维化的风险增加相关。与无代谢合并症的 NASH 患者相比，同时存在四种代谢合并症的 NASH 患者发生≥F3 的风险更高（OR 1.56，95%CI 1.40-1.73，p<0.001）。总之，美国成年人中 NASH 伴晚期纤维化的患病率高达 6.90%，NASH 伴肝硬化的患病率高达 3.67%，这意味着如果使用估计的 7500 万患有 NASH 的美国成年人，这一数字分别为 518 万和 275 万。NASH 患者中代谢合并症与晚期纤维化风险增加相关。
