非裔美国人具有独特的临床和组织学特征，与白种人相比，非酒精性脂肪性肝炎（NASH）和晚期纤维化的患病率较低。
African Americans have a distinct clinical and histologic profile with lower prevalence of NASH and advanced fibrosis relative to Caucasians.
机构信息
Division of Transplant Surgery, Department of Surgery, Methodist University Hospital Transplant Institute, University of Tennessee Health Science Center, Memphis, Tennessee.
Division of Hepatology and Liver Transplantation, Sandra Atlas Bass Center for Liver Diseases, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York.
出版信息
Eur J Gastroenterol Hepatol. 2021 Mar 1;33(3):388-398. doi: 10.1097/MEG.0000000000001735.
BACKGROUND AND AIMS
Racial/ethnic disparities have been reported in the prevalence of nonalcoholic fatty liver disease (NAFLD). Thus, we aimed to understand the inter-ethnic clinical, biochemical, and histological differences in a large cohort of Caucasians and African-Americans (AA).
METHODS
Laboratory and liver biopsy data of 942 NAFLD patients were retrospectively analyzed. Nine hundred seven patients were included in the analysis: 677 (74.6%) Caucasians and 230 (25.3%) AA.
RESULTS
AA had higher mean BMI compared to Caucasians (42.6 ± 9.5 vs. 39 ± 8.6 kg/m2). The prevalence of nonalcoholic steatohepatitis (NASH), defined by NAFLD activity score (NAS . 5), was higher in the Caucasians (n = 67) compared to AA (n = 7) (9.8% vs. 3%, P = 0.0007). One hundred fifteen patients (12.8%) had advanced fibrosis: 109 (16.2%) Caucasians and six (2.6%) AA. No AA patients had stage 4 fibrosis or cirrhosis. Multivariate logistic regression analysis revealed advanced fibrosis was significantly associated with age at liver biopsy (OR 1.03, 95% CI 1.0.1.1, P = 0.017, lower platelet count (OR 0.99, 95% CI 0.98.0.99, P = <0.0001), AST/ALT ratio (OR 5.19, 95% CI 2.9.9.2, P <0.0001) and Caucasian race (OR 7.49, 95% CI 2.53.22.2, P = 0.0003). Advanced fibrosis in AA was predicted by lower platelet count and AST/ALT ratio. Whereas Advanced fibrosis in Caucasians was predicted by age at biopsy, lower platelet count and AST/ALT ratio.
CONCLUSION
The AA have a distinct clinical and histologic phenotype. Caucasians have a significantly greater proportion of NASH and are eight times more likely to develop advanced fibrosis than AA.
背景和目的
非酒精性脂肪性肝病（NAFLD）的患病率存在种族/民族差异。因此，我们旨在了解大型白种人和非裔美国人（AA）队列中种族间的临床、生化和组织学差异。
方法
回顾性分析了 942 例 NAFLD 患者的实验室和肝活检数据。907 例患者纳入分析：677 例（74.6%）为白种人，230 例（25.3%）为 AA。
结果
AA 的平均 BMI 高于白种人（42.6±9.5 与 39±8.6kg/m2）。白种人中非酒精性脂肪性肝炎（NASH）的患病率较高（定义为 NAFLD 活动评分（NAS≥5），n=67 与 AA（n=7）（9.8%比 3%，P=0.0007）。115 例（12.8%）患者存在晚期纤维化：109 例（16.2%）为白种人，6 例（2.6%）为 AA。无 AA 患者存在 4 期纤维化或肝硬化。多变量 logistic 回归分析显示，晚期纤维化与肝活检时的年龄显著相关（OR 1.03，95%CI 1.011.05，P=0.017），血小板计数较低（OR 0.99，95%CI 0.980.99，P<0.0001），AST/ALT 比值（OR 5.19，95%CI 2.999.20，P<0.0001）和白种人种族（OR 7.49，95%CI 2.5322.2，P=0.0003）。AA 中晚期纤维化由较低的血小板计数和 AST/ALT 比值预测。而白种人中晚期纤维化则由活检时的年龄、较低的血小板计数和 AST/ALT 比值预测。
结论
AA 具有独特的临床和组织学表型。白种人患 NASH 的比例显著更高，发生晚期纤维化的可能性是非裔美国人的八倍。
Zotero 插件