Department of Nephrology, Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, China; Department of Nephrology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China.
NAFLD Research Centre, Department of Hepatology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China.
Diabetes Metab. 2020 Sep;46(4):288-295. doi: 10.1016/j.diabet.2019.11.003. Epub 2019 Nov 28.
The association between Liver fibrosis (LF), as assessed by either histology or Liver stiffness measurement (LSM), and the presence of Early kidney dysfunction (EKD) was investigated in this study, as was also the diagnostic performance of LSM for identifying the presence of EKD in patients with Non-alcoholic fatty liver disease (NAFLD).
A total of 214 adults with non-cirrhotic biopsy-proven NAFLD were recruited from two independent medical centres. Their histological stage of LF was quantified using Brunt's criteria. Vibration-controlled Transient elastography (TE), using M-probe (FibroScan®) ultrasound, was performed in 154 patients and defined as significant when LSM was≥8.0kPa. EKD was defined as the presence of microalbuminuria with an estimated glomerular filtration rate≥60mL/min/1.73 m. Logistic regression modelling was used to estimate the likelihood of having EKD with NAFLD (LSM-EKD model).
The prevalence of EKD was higher in patients with vs without LF on histology (22.14% vs 4.82%, respectively; P<0.001) and, similarly, EKD prevalence was higher in patients with LSM≥8.0kPa vs LSM<8.0kPa (23.81% vs 6.59%, respectively; P<0.05). The area under the ROC curve of the LSM-EKD model for identifying EKD was 0.80 (95% CI: 0.72-0.89). LF detected by either method was associated with EKD independently of established renal risk factors and potential confounders.
LF was independently associated with EKD in patients with biopsy-proven NAFLD. Thus, TE-measured LSM, a widely used technique for quantifying LF, can accurately identify those patients with NAFLD who are at risk of having EKD.
本研究旨在探讨肝脏纤维化（LF）的评估（通过组织学或肝脏硬度测量[LSM]）与早期肾功能障碍（EKD）的存在之间的关系，以及 LSM 对识别非酒精性脂肪性肝病（NAFLD）患者 EKD 存在的诊断性能。
从两个独立的医疗中心招募了 214 名非肝硬化活检证实的非酒精性脂肪性肝病成人患者。使用 Brunt 标准对其 LF 的组织学分期进行量化。在 154 名患者中进行了振动控制瞬态弹性成像（TE），使用 M 探头（FibroScan®）超声，当 LSM≥8.0kPa 时定义为显著。EKD 定义为存在肾小球滤过率≥60mL/min/1.73 m 的微量白蛋白尿。使用逻辑回归模型估计有 EKD 的 NAFLD 患者的可能性（LSM-EKD 模型）。
组织学上有 LF 的患者中 EKD 的患病率高于无 LF 的患者（分别为 22.14%和 4.82%；P<0.001），同样，LSM≥8.0kPa 的患者中 EKD 的患病率高于 LSM<8.0kPa 的患者（分别为 23.81%和 6.59%；P<0.05）。用于识别 EKD 的 LSM-EKD 模型的 ROC 曲线下面积为 0.80（95%CI：0.72-0.89）。两种方法检测到的 LF 独立于既定的肾脏危险因素和潜在的混杂因素与 EKD 相关。
在活检证实的 NAFLD 患者中，LF 与 EKD 独立相关。因此，广泛用于量化 LF 的 TE 测量 LSM 可以准确识别出那些患有 EKD 风险的 NAFLD 患者。
