Khoudari George, Singh Amandeep, Noureddin Mazen, Fritze Danielle, Lopez Rocio, Asaad Imad, Lawitz Eric, Poordad Fred, Kowdley Kris V, Alkhouri Naim
Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, United States.
Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH 44195, United States.
World J Hepatol. 2019 Oct 27;11(10):710-718. doi: 10.4254/wjh.v11.i10.710.
Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome (MetS) and is characterized by steatosis in the absence of significant alcohol consumption. However, MetS and significant alcohol intake coexist in certain individuals which may lead to the development of BAFLD.
To assess the clinical characteristics of patients with both alcoholic and NAFLD (BAFLD) in a large cohort in the United States.
Adults from the National Health and Nutrition Examination Survey between 2003-2014 were included. NAFLD was diagnosed based on elevated alanine aminotransferase (ALT) and being overweight or obese in the absence of other liver diseases. BAFLD patients met the criteria for NAFLD but also had either MetS or type 2 diabetes and consumed excessive amounts of alcohol. Univariable and multivariable analysis were performed to assess differences between NAFLD and BAFLD and to compare severity based on a validated fibrosis score (FIB4 index).
The prevalence of NAFLD was at 25.9% (95%CI; 25.1-26.8) and that of BAFLD was 0.84% (0.67, 1.02) which corresponds to an estimated 1.24 million Americans affected by BAFLD. Compared to NAFLD, patients with BAFLD were more likely to be male, smokers, have higher ALT, aspartate aminotransferase, triglycerides, and lower platelets; < 0.01 for all. More importantly, after adjusting for MetS components, BAFLD patients were significantly more likely to have advanced fibrosis [adjusted OR (95%CI) based on FIB4 index > 2.67 was 3.2 (1.4, 7.0), = 0.004].
A significant percentage of the American general population is afflicted by BAFLD and these patients tend to have more advanced liver fibrosis.
非酒精性脂肪性肝病（NAFLD）是代谢综合征（MetS）的肝脏表现，其特征是在无大量饮酒情况下出现脂肪变性。然而，在某些个体中，MetS与大量饮酒并存，这可能导致混合型酒精性脂肪性肝病（BAFLD）的发生。
评估美国一个大型队列中同时患有酒精性肝病和NAFLD（BAFLD）患者的临床特征。
纳入2003年至2014年美国国家健康与营养检查调查中的成年人。NAFLD根据丙氨酸氨基转移酶（ALT）升高且在无其他肝脏疾病情况下超重或肥胖来诊断。BAFLD患者符合NAFLD标准，但同时患有MetS或2型糖尿病且饮酒过量。进行单变量和多变量分析以评估NAFLD和BAFLD之间的差异，并根据经过验证的纤维化评分（FIB4指数）比较严重程度。
NAFLD的患病率为25.9%（95%可信区间；25.1 - 26.8），BAFLD的患病率为0.84%（0.67，1.02），这相当于估计有124万美国人受BAFLD影响。与NAFLD相比，BAFLD患者更可能为男性、吸烟者，ALT、天冬氨酸氨基转移酶、甘油三酯水平更高，血小板更低；所有差异均P < 0.01。更重要的是，在对MetS各组分进行校正后，BAFLD患者发生晚期纤维化的可能性显著更高[基于FIB4指数> 2.67的校正比值比（95%可信区间）为3.2（1.4，7.0），P = 0.004]。
相当比例的美国普通人群患有BAFLD，且这些患者往往有更严重的肝纤维化。
