美国普通人群的血压、血糖状况和通过瞬时弹性成像评估的晚期肝纤维化。

Blood pressure, glycemic status and advanced liver fibrosis assessed by transient elastography in the general United States population.

机构信息

Department of Medicine and Rehabilitation, Policlinico di Monza, Monza.

Department of Medicine and Surgery.

出版信息

J Hypertens. 2021 Aug 1;39(8):1621-1627. doi: 10.1097/HJH.0000000000002835.

DOI:10.1097/HJH.0000000000002835

PMID:33657584

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9904436/

Abstract

OBJECTIVE

Few studies investigated the role of different predictors of advanced liver fibrosis in unselected populations. Here, we estimate the prevalence of steatosis and fibrosis in the general United States population by means of transient elastography and evaluate the impact of blood pressure (BP) and diabetes on disease severity.

METHODS

This is a cross-sectional study of United States adults participating in the 2017-2018 cycle of the National Health and Nutrition Examination Survey. Participants underwent a transient elastography examination, and liver steatosis and fibrosis were estimated through the controlled attenuation parameter (CAP) score and liver stiffness measurement (LSM), respectively.

RESULTS

Four thousand, three hundred and seventy-one participants had reliable transient elastography and BP readings. Steatosis (CAP ≥ 248 dB/m), advanced fibrosis (LSM ≥ 9.6 kPa) and cirrhosis (LSM ≥ 13 kPa) were present in 56.9, 5.5 and 2.9% of participants, respectively. After controlling for potential confounders, risk of steatosis increased proportionally going from participants with optimal (reference) to those with normal [odds ratio (OR) 1.24, 95% confidence interval (CI) 0.83-1.86], high normal (OR 1.41, 95% CI 1.01-1.97) and elevated BP (OR 1.64, 95% CI 1.21-2.21), whereas no significant association was found between BP status and liver fibrosis. Conversely, presence of diabetes increased the risk of both steatosis (OR 2.15, 95% CI 1.49-3.11) and advanced fibrosis (OR 2.25, 95% CI 1.36-3.72).

CONCLUSION

Liver steatosis and fibrosis are highly prevalent in the multiethnic United States adult population, raising concerns for future incidence of cirrhosis and its complications. BP status was associated with a progressively higher risk of steatosis, whereas obesity and diabetes were consistently associated with both steatosis and fibrosis.

摘要

目的

很少有研究调查非选择性人群中不同预测因素对晚期肝纤维化的作用。在此，我们通过瞬时弹性成像评估普通美国人群中脂肪变性和纤维化的患病率，并评估血压（BP）和糖尿病对疾病严重程度的影响。

方法

这是一项横断面研究，纳入了参加 2017-2018 年美国国家健康和营养调查（NHANES）周期的美国成年人。参与者接受了瞬时弹性成像检查，通过受控衰减参数（CAP）评分和肝硬度测量（LSM）分别估计肝脂肪变性和纤维化。

结果

4371 名参与者有可靠的瞬时弹性成像和 BP 读数。脂肪变性（CAP≥248dB/m）、晚期纤维化（LSM≥9.6kPa）和肝硬化（LSM≥13kPa）分别在 56.9%、5.5%和 2.9%的参与者中存在。在控制潜在混杂因素后，与最佳（参考）相比，正常（OR 1.24，95%CI 0.83-1.86）、高正常（OR 1.41，95%CI 1.01-1.97）和升高的 BP（OR 1.64，95%CI 1.21-2.21）的参与者发生脂肪变性的风险呈比例增加，而 BP 状态与肝纤维化之间无显著相关性。相反，糖尿病的存在增加了脂肪变性（OR 2.15，95%CI 1.49-3.11）和晚期纤维化（OR 2.25，95%CI 1.36-3.72）的风险。