Division of Cardiovascular Disease Research, Department for Chronic Disease Convergence Research, Korea National Institute of Health, Cheongju, Republic of Korea.
Division of Endocrinology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea.
Hepatol Int. 2021 Oct;15(5):1148-1159. doi: 10.1007/s12072-021-10209-3. Epub 2021 Jun 3.
Nonalcoholic fatty liver disease (NAFLD) is associated with atherosclerotic cardiovascular disease (ASCVD). However, few studies have investigated the association between the histological severity of NAFLD and ASCVD. Therefore, we investigated whether the histological severity of NAFLD is associated with ASCVD risk.
We performed cross-sectional analysis of prospectively enrolled, biopsy-proven NAFLD patients. The 10-year ASCVD risk was assessed using the Korean Risk Prediction Model. The histological spectrum of NAFLD was classified by the nonalcoholic steatohepatitis (NASH) clinical research network histological scoring system. The association between each histological subgroup and ASCVD risk was analyzed using logistic regression analysis.
This study included 398 Korean subjects (mean age, 57.9 years; male, 44.2%) with biopsy-proven NAFLD and 102 no-NALFD controls. Subjects with ASCVD risk ≥ 10% showed more severe grades of hepatocellular ballooning and more advanced stages of fibrosis when compared with subjects with ASCVD risk < 10% (p < 0.05 for each). The presence of NASH (odds ratio [OR] 4.07; 95% confidence interval [CI] 1.40-11.88) or advanced fibrosis (OR 8.11; 95% CI 1.83-35.98) was independently associated with a higher risk of ASCVD even after adjustment for age, sex, body mass index, blood pressure, lipids, liver enzymes, systemic inflammation, and insulin resistance.
Patients with NASH or advanced fibrosis are at an increased risk of developing ASCVD compared with no-NAFLD controls or subjects with NAFL, independent of conventional metabolic risk factors for CVD. Histological information on NAFLD may be helpful to promote our understanding of extrahepatic complications, such as ASCVD, resulting from NAFLD progression.
非酒精性脂肪性肝病（NAFLD）与动脉粥样硬化性心血管疾病（ASCVD）相关。然而，很少有研究调查 NAFLD 的组织学严重程度与 ASCVD 之间的关系。因此，我们研究了 NAFLD 的组织学严重程度是否与 ASCVD 风险相关。
我们对前瞻性纳入的、经活检证实的 NAFLD 患者进行了横断面分析。使用韩国风险预测模型评估 10 年 ASCVD 风险。使用非酒精性脂肪性肝炎（NASH）临床研究网络组织学评分系统对 NAFLD 的组织学谱进行分类。使用 logistic 回归分析分析每个组织学亚组与 ASCVD 风险之间的关系。
本研究纳入了 398 名韩国受试者（平均年龄 57.9 岁；男性占 44.2%），均经活检证实为 NAFLD，102 名为非 NAFLD 对照组。与 ASCVD 风险<10%的受试者相比，ASCVD 风险≥10%的受试者肝细胞气球样变的严重程度更高，纤维化分期更晚期（每项 p<0.05）。存在 NASH（比值比[OR]4.07；95%置信区间[CI]1.40-11.88）或晚期纤维化（OR 8.11；95%CI 1.83-35.98）与 ASCVD 风险增加独立相关，即使在调整了年龄、性别、体重指数、血压、血脂、肝酶、全身炎症和胰岛素抵抗等传统心血管疾病代谢危险因素后也是如此。
与非 NAFLD 对照组或无 NAFLD 的受试者相比，患有 NASH 或晚期纤维化的患者发生 ASCVD 的风险增加，这与 ASCVD 的传统代谢危险因素无关。NAFLD 的组织学信息可能有助于我们更好地理解由 NAFLD 进展引起的 ASCVD 等肝外并发症。
