Graduate Program in Gastroenterology and Hepatology, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil.
Experimental Laboratory of Hepatology and Gastroenterology, Center for Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Hepatol Int. 2021 Apr;15(2):380-391. doi: 10.1007/s12072-021-10157-y. Epub 2021 Mar 10.
BACKGROUND/PURPOSE: Cardiovascular disease (CVD) is the leading cause of death among individuals with non-alcoholic fatty liver disease (NAFLD). Recently, NAFLD was renamed metabolic-associated fatty liver disease (MAFLD). This study aimed to compare cardiovascular risk (CVR) and CVD between patients with NAFLD and MAFLD.
Retrospective cross-sectional study of biopsy-proven liver steatosis performed between 2013 and 2018 at a university hospital. Cases were divided into NAFLD or MAFLD and demographic, clinical, and laboratory data were collected to assess CVR (through the atherosclerotic cardiovascular disease risk estimator and atherogenic indices) and CVD.
Out of 1233 liver biopsies, 171 (13.9%) presented steatosis. Of these, 109 patients met diagnostic criteria for NAFLD (63.7%) and 154 (90.1%), for MAFLD. In the NAFLD group, 78% of the cases had steatohepatitis, 24.8% had cirrhosis, and 3.7%, hepatocellular carcinoma (HCC). In the MAFLD group, 72.7% of the cases had liver inflammatory activity, 28.6% had cirrhosis, and 13.6% had HCC. In patients with MAFLD and NAFLD, CVR was intermediate/high (36.4 and 25.7%, p = 0.209) and CVD occurred in 20.1 and 12.8% (p = 0.137) of the cases, respectively, with no influence of liver injury severity. We observed a significant increase in high 10-year CVR (p = 0.020) and CVD (p = 0.007) in patients with MAFLD and concomitant viral infection (HCV and/or HBV) compared to cases with MAFLD only.
Patients with both NAFLD and MAFLD had intermediate/high CVR, with a high rate of CVD. Patients with MAFLD and concomitant viral infection showed significantly increased CVR and CVD compared to those without viral infection.
背景/目的：心血管疾病（CVD）是非酒精性脂肪性肝病（NAFLD）患者死亡的主要原因。最近，NAFLD 更名为代谢相关脂肪性肝病（MAFLD）。本研究旨在比较 NAFLD 和 MAFLD 患者的心血管风险（CVR）和 CVD。
这是一项回顾性、横断面研究，对 2013 年至 2018 年间在一所大学医院进行的肝活检证实的脂肪性肝病患者进行研究。病例分为 NAFLD 或 MAFLD，并收集人口统计学、临床和实验室数据，以评估 CVR（通过动脉粥样硬化性心血管疾病风险估计器和致动脉粥样硬化指数）和 CVD。
在 1233 例肝活检中，有 171 例（13.9%）存在脂肪变性。其中，109 例符合 NAFLD 诊断标准（63.7%），154 例（90.1%）符合 MAFLD 诊断标准。在 NAFLD 组中，78%的病例有脂肪性肝炎，24.8%有肝硬化，3.7%有肝细胞癌（HCC）。在 MAFLD 组中，72.7%的病例有肝脏炎症活动，28.6%有肝硬化，13.6%有 HCC。在 MAFLD 和 NAFLD 患者中，CVR 为中/高（36.4%和 25.7%，p=0.209），CVD 分别发生在 20.1%和 12.8%（p=0.137）的病例中，与肝损伤严重程度无关。我们观察到，与单纯 MAFLD 患者相比，合并病毒感染（HCV 和/或 HBV）的 MAFLD 患者的高 10 年 CVR（p=0.020）和 CVD（p=0.007）显著增加。
患有 NAFLD 和 MAFLD 的患者 CVR 为中/高，CVD 发生率高。合并病毒感染的 MAFLD 患者的 CVR 和 CVD 明显高于无病毒感染的患者。
