沙特阿拉伯非酒精性脂肪性肝病患者的临床和代谢特征：来自系统性肝病观察登记处（SOLID）的数据。
Clinical and Metabolic Characteristics of Non-Alcoholic Fatty Liver Disease Patients in Saudi Arabia: Data from the Systematic Observatory Liver Disease (SOLID) Registry.
作者信息
Alswat Khalid, Sanai Faisal M, Al-Hamoudi Waleed, Ismail Mona, Dahlan Yaser, AlGhamdi Hamdan Saleh, Altraif Ibrahim, Alalwan Abduljaleel, Babatin Mohamed M A, Alqahtani Saleh A
机构信息
Liver Disease Research Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Gastroenterology Unit, Department of Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
出版信息
Diabetes Metab Syndr Obes. 2021 Mar 16;14:1167-1175. doi: 10.2147/DMSO.S300051. eCollection 2021.
BACKGROUND AND AIMS
The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing in Saudi Arabia (SA), but descriptions of the clinical and metabolic characteristics of these patients are limited. The present study aims to fill this gap.
METHODS
Demographic, clinical, and laboratory data of all NAFLD patients from 2009 to 2019 were retrieved from the Systematic Observatory Liver Disease Registry (SOLID) [n=832 (337 males; 495 females); mean (± standard deviation, SD) age was 42.6±13.6 years; mean body mass index (BMI) was 35.0±9.3kg/m]. Non-invasive surrogate scores of fibrosis (eg AST to Platelet Ratio Index (APRI), Fibrosis-4 (FIB-4), and NAFLD fibrosis (NFS) scores) were calculated and analyzed. In addition, data from NAFLD patients with normal and high alanine aminotransferase (ALT) were compared using two different methods: the standard laboratory reference range which defines normal as ALT<61 IU/L, and the range proposed by a recent national study which sets upper limits of normal ALT at 33 IU/l for men and 22 IU/l for women.
RESULTS
Hyperlipidemia was the most common comorbidity (41.7%), followed by type 2 diabetes mellitus (T2DM) (35.3%) and hypertension (28.4%). Prevalence of advanced fibrosis varied widely across definitions [FIB-4, N=19 (2.5%); APRI, N=21 (2.8%); NFS, N=62 (8.6%)] and exhibited sexual dimorphism with males having worse metabolic characteristics. NAFLD patients with normal ALT were more likely to be older, female, have a lower BMI, and have a higher prevalence of cirrhosis, DM, hypertension, hyperlipidemia, and renal dysfunction.
CONCLUSION
Patients with NAFLD have metabolic characteristics associated with several comorbidities, including NAFLD patients with normal ALT. Mechanistic studies are needed to examine and analyze complex, interactive effects between sex, age, and other factors that may accelerate NAFLD disease progression.
背景与目的
非酒精性脂肪性肝病（NAFLD）在沙特阿拉伯（SA）的患病率正在上升，但对这些患者的临床和代谢特征的描述有限。本研究旨在填补这一空白。
方法
从系统性肝病观察登记处（SOLID）检索2009年至2019年所有NAFLD患者的人口统计学、临床和实验室数据[n = 832（337名男性；495名女性）；平均（±标准差，SD）年龄为42.6±13.6岁；平均体重指数（BMI）为35.0±9.3kg/m²]。计算并分析纤维化的非侵入性替代评分（如AST与血小板比值指数（APRI）、纤维化-4（FIB-4）和NAFLD纤维化（NFS）评分）。此外，使用两种不同方法比较了丙氨酸氨基转移酶（ALT）正常和升高的NAFLD患者的数据：标准实验室参考范围将正常定义为ALT<61 IU/L，以及最近一项全国性研究提出的范围，该研究将男性ALT正常上限设定为33 IU/L，女性为22 IU/L。
结果
高脂血症是最常见的合并症（41.7%），其次是2型糖尿病（T2DM）（35.3%）和高血压（28.4%）。根据不同定义，晚期纤维化的患病率差异很大[FIB-4，N = 19（2.5%）；APRI，N = 21（2.8%）；NFS，N = 62（8.6%）]，并且存在性别差异，男性的代谢特征更差。ALT正常的NAFLD患者更可能年龄较大、为女性、BMI较低，并且肝硬化、糖尿病、高血压、高脂血症和肾功能不全的患病率更高。
结论
NAFLD患者具有与多种合并症相关的代谢特征，包括ALT正常的NAFLD患者。需要进行机制研究来检查和分析性别、年龄和其他可能加速NAFLD疾病进展的因素之间复杂的相互作用。
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