Choi Catherine J, Weiss Stanley H, Nasir Umair M, Pyrsopoulos Nikolaos T
Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ 07101, United States.
Department of Medicine, Biostatistics and Epidemiology, Rutgers New Jersey Medical School, Newark, NJ 07103, United States.
World J Hepatol. 2020 Nov 27;12(11):993-1003. doi: 10.4254/wjh.v12.i11.993.
Recent studies have revealed the endocannabinoid system as a potential therapeutic target in the management of nonalcoholic fatty liver disease (NAFLD). Cannabis use is associated with reduced risk for NAFLD, we hypothesized that cannabis use would be associated with less liver-related clinical complications in patients with NAFLD.
To assess the effects of cannabis use on liver-related clinical outcomes in hospitalized patients with NAFLD.
We performed a retrospective matched cohort study based on querying the 2014 National Inpatient Sample (NIS) for hospitalizations of adults with a diagnosis of NAFLD. The NIS database is publicly available and the largest all-payer inpatient database in the United States. The patients with cannabis use were selected as cases and those without cannabis were selected as controls. Case-control matching at a ratio of one case to two controls was performed based on sex, age, race, and comorbidities. The liver-related outcomes such as portal hypertension, ascites, varices and variceal bleeding, and cirrhosis were compared between the groups.
A total of 49911 weighed hospitalizations with a diagnosis of NAFLD were identified. Of these, 3820 cases were selected as the cannabis group, and 7625 non-cannabis cases were matched as controls. Patients with cannabis use had a higher prevalence of ascites (4.5% 3.6%), with and without cannabis use, = 0.03. The prevalence of portal hypertension (2.1% 2.2%), varices and variceal bleeding (1.3% 1.7%), and cirrhosis (3.7% 3.6%) was not different between the groups, with and without cannabis use, all > 0.05. Hyperlipidemia, race/ethnicity other than White, Black, Asian, Pacific Islander or Native American, and higher comorbidity score were independent risk factors for ascites in the cannabis group. Among non-cannabis users, obesity and hyperlipidemia were independent protective factors against ascites while older age, Native American and higher comorbidity index were independent risk factors for ascites.
Cannabis was associated with higher rates of ascites, but there was no statistical difference in the prevalence of portal hypertension, varices and variceal bleeding, and cirrhosis.
近期研究表明，内源性大麻素系统是管理非酒精性脂肪性肝病（NAFLD）的一个潜在治疗靶点。大麻使用与NAFLD风险降低相关，我们推测大麻使用与NAFLD患者较少的肝脏相关临床并发症有关。
评估大麻使用对住院NAFLD患者肝脏相关临床结局的影响。
我们通过查询2014年国家住院患者样本（NIS）中诊断为NAFLD的成人住院病例，进行了一项回顾性匹配队列研究。NIS数据库是公开可用的，也是美国最大的全付费者住院数据库。选择使用大麻的患者作为病例组，未使用大麻的患者作为对照组。根据性别、年龄、种族和合并症，以1例病例对2例对照的比例进行病例对照匹配。比较两组之间肝脏相关结局，如门静脉高压、腹水、静脉曲张和曲张静脉出血以及肝硬化。
共识别出49911例诊断为NAFLD的加权住院病例。其中，3820例病例被选为大麻组，7625例非大麻病例被匹配为对照组。使用大麻的患者腹水患病率较高（4.5%对3.6%），P = 0.03。使用和未使用大麻的两组之间门静脉高压（2.1%对2.2%）、静脉曲张和曲张静脉出血（1.3%对1.7%）以及肝硬化（3.7%对3.6%）的患病率无差异，均P>0.05。高脂血症、非白人、黑人、亚洲人、太平洋岛民或美洲原住民以外的种族/族裔以及较高的合并症评分是大麻组腹水的独立危险因素。在未使用大麻的人群中，肥胖和高脂血症是腹水的独立保护因素，而年龄较大、美洲原住民和较高的合并症指数是腹水的独立危险因素。
大麻与较高的腹水发生率相关，但门静脉高压、静脉曲张和曲张静脉出血以及肝硬化的患病率无统计学差异。
