Arnouk Joud, Rachakonda Vikrant P, Jaiyeola Diana, Behari Jaideep
Division of Gastroenterology, Hepatology and Nutrition Department of Medicine University of Pittsburgh School of Medicine Pittsburgh PA.
St. Luke's University Health System Bethlehem PA.
Hepatol Commun. 2020 Jul 21;4(10):1419-1429. doi: 10.1002/hep4.1572. eCollection 2020 Oct.
Nonalcoholic fatty liver disease (NAFLD) is closely associated with obesity. The prevalence of extreme obesity, defined as body mass index (BMI) of 50 kg/m or higher, is rising more rapidly than overall obesity. We aimed to compare the clinical outcomes and performance of noninvasive fibrosis assessment tools in NAFLD with or without extreme obesity. A retrospective analysis was performed in 304 patients with NAFLD with extreme obesity and compared them to patients with NAFLD with BMI of 40 kg/m or less, matched for age, gender, race, and liver fibrosis stage. The mean age of the NAFLD with extreme obesity cohort was 55.9 years, BMI 55 kg/m, and 49.7% had cirrhosis at initial evaluation. Baseline cirrhosis and coronary artery disease were associated with increased risk of death, and dyslipidemia with decreased risk of mortality. Age, insulin use, hypertension, albumin and platelet count were associated with cirrhosis. Fifteen percent of patients had weight-loss surgery, but this was not associated with survival or risk of cirrhosis. Of the 850 abdominal ultrasound scans performed in 255 patients, 24.1% were deemed suboptimal for hepatocellular carcinoma screening. The mean NAFLD fibrosis score (NFS) in the extreme obesity cohort, versus a propensity-matched cohort with BMI of 40 kg/m or less, was significantly different for both low fibrosis (F0-F2) (0.222 vs. -1.682, < 0.0001) and high fibrosis (F3-F4) (2.216 vs. 0.557, < 0.001). NAFLD with extreme obesity is associated with increased risk of liver-related and overall mortality. Accurate noninvasive assessment of liver fibrosis, low rates of weight loss surgery, and high failure rate of ultrasound were identified as clinical challenges in this population.
非酒精性脂肪性肝病（NAFLD）与肥胖密切相关。极端肥胖的患病率，定义为体重指数（BMI）达到50kg/m²或更高，其增长速度比总体肥胖更快。我们旨在比较有无极端肥胖的NAFLD患者中，非侵入性纤维化评估工具的临床结果和表现。对304例极端肥胖的NAFLD患者进行了回顾性分析，并将其与年龄、性别、种族和肝纤维化阶段相匹配的BMI为40kg/m²或更低的NAFLD患者进行比较。极端肥胖的NAFLD队列的平均年龄为55.9岁，BMI为55kg/m²，初始评估时有49.7%的患者患有肝硬化。基线肝硬化和冠状动脉疾病与死亡风险增加相关，血脂异常与死亡风险降低相关。年龄、胰岛素使用、高血压、白蛋白和血小板计数与肝硬化相关。15%的患者接受了减肥手术，但这与生存率或肝硬化风险无关。在255例患者进行的850次腹部超声检查中，24.1%被认为不适合用于肝细胞癌筛查。极端肥胖队列的平均NAFLD纤维化评分（NFS）与BMI为40kg/m²或更低的倾向匹配队列相比，低纤维化（F0 - F2）（0.222对 -1.682，P < 0.0001）和高纤维化（F3 - F4）（2.216对0.557，P < 0.001）均有显著差异。极端肥胖的NAFLD与肝脏相关和全因死亡率风险增加相关。准确的肝纤维化非侵入性评估、低减肥手术率和超声检查的高失败率被确定为该人群的临床挑战。
