Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan II Road, Yuexiu District, Guangzhou 510080 China.
Department of Gastroenterology, First Affiliated Hospital, Guangzhou Medical College, Guangzhou 510000, Guangdong, China.
Dig Liver Dis. 2021 Dec;53(12):1610-1619. doi: 10.1016/j.dld.2021.02.003. Epub 2021 Mar 17.
Advanced Non-alcoholic fatty liver disease (NAFLD) is associated with increased risk of cardiovascular disease (CVD).
We determine whether combinations of ultrasound graphic steatosis grades, fibrosis scores and apolipoprotein levels add value to CVD risk prediction in NAFLD patients.
The retrospective cohort study enrolled 10,453 individuals (3519 NAFLD; 6934 non NAFLD) from 2004 to 2018. Hepatic ultrasound measurements, lipid and apolipoprotein profiles, Fibrosis-4 and the NAFLD fibrosis scores (NFS) were assessed. The primary outcome included both clinical and subclinical CVD.
During 116-month follow-up period, there were 957 clinical and 752 subclinical CVD events. NAFLD patients had a higher incidence of CVD than non NAFLD patients as the steatosis degree, NFS, and FIB4 scores increased (25.1% vs 11.9%, Log Rank: p < 0.001). For the lipid and apolipoprotein profiles excluding triglyceride or ApoE, subjects with varied steatosis severity in the upper two tertiles had different risk of CVD (p for interaction < 0.001). A nomogram model combination of Framingham Risk Score (FRS), NFS and apolipoprotein profiles presented a higher AUC than FRS in a time-dependent ROC curve (0.816 vs 0.752, p < 0.001).
The novel risk score considering ultrasonography-defined steatosis grades, non-invasive liver fibrosis scores and apolipoprotein profiles accurately predicted the 10-year risk of CVD.
非酒精性脂肪性肝病（NAFLD）的进展与心血管疾病（CVD）风险增加有关。
我们旨在确定超声脂肪肝分级、纤维化评分和载脂蛋白水平的组合是否能为 NAFLD 患者的 CVD 风险预测提供附加价值。
这项回顾性队列研究纳入了 2004 年至 2018 年期间的 10453 名个体（3519 名 NAFLD；6934 名非 NAFLD）。评估了肝脏超声测量值、血脂和载脂蛋白谱、肝纤维化-4 指数（FIB-4）和非酒精性脂肪性肝病纤维化评分（NFS）。主要结局包括临床和亚临床 CVD。
在 116 个月的随访期间，发生了 957 例临床 CVD 事件和 752 例亚临床 CVD 事件。随着脂肪肝程度、NFS 和 FIB-4 评分的增加，NAFLD 患者的 CVD 发生率高于非 NAFLD 患者（25.1%比 11.9%，Log Rank：p<0.001）。对于排除甘油三酯或载脂蛋白 E 的血脂和载脂蛋白谱，在两个较高的脂肪肝严重程度组中，患者的 CVD 风险不同（p 值<0.001）。在时间依赖性 ROC 曲线中，Framingham 风险评分（FRS）、NFS 和载脂蛋白谱的列线图模型组合的 AUC 高于 FRS（0.816 比 0.752，p<0.001）。
该新型风险评分考虑了超声定义的脂肪肝分级、非侵入性肝纤维化评分和载脂蛋白谱，可准确预测 10 年 CVD 风险。
