Navarroza Ann Margaret C, Wong Stephen N
Section of Gastroenterology, University of Santo Tomas Hospital, Manila, Philippines.
Section of Gastroenterology, Chinese General Hospital and Medical Center, Manila, Philippines.
Indian J Gastroenterol. 2021 Aug;40(4):380-388. doi: 10.1007/s12664-021-01184-6. Epub 2021 Jul 2.
Data on nonalcoholic fatty liver disease (NAFLD) in the Philippines are scarce. We aimed to compare the clinical and biochemical profiles of lean (BMI<23) vs. non-lean (BMI≥23) NAFLD patients.
Consecutive patients diagnosed with NAFLD on ultrasound in two outpatient hepatology clinics from February 2007-January 2017 were included. Patients with significant alcohol intake, alternative causes of steatosis, and incomplete data were excluded.
A total of 663 patients (57.9% male) were included. Most patients were non-lean (88.1%) and had an elevated alanine aminotransferase (ALT) (63%). Cirrhosis or hepatocellular carcinoma (HCC) were already present in 8.4% on initial consultation. Concomitant hepatitis B was equally common in patients with and without cirrhosis (20.7% vs. 17.5%; p=0.660) or HCC (17.9% vs. 12.8%; p=0.415). Independent factors associated with HCC/cirrhosis on initial consultation were older age (OR=1.038), low albumin (OR=0.428), high BARD score (BMI, AST/ALT ratio, T2 diabetes mellitus; OR=2.548) and the presence of symptoms (OR=1.808). Compared to lean NAFLD patients, non-lean patients were more likely to be younger (51.5±14.4 vs. 55±14.3; p=0.003), have DM (47.9% vs. 29.1%; p=0.002), hypertension (57.5% vs. 38%; p=0.001), dyslipidemia (73.1% vs. 54.4%; p=0.001) and metabolic syndrome (60.3% vs. 30.4%; p<0.0001), abnormal metabolic parameters (LDL-C, HDL-C, triglycerides, uric acid and FBS), and with elevated ALT (65.2% vs. 46.8%; p=0.002) and AST (41.1±29.6 vs. 35.3±28.3; p=0.008).
The proportion of lean NAFLD was 11.9%. Although metabolic derangements and its clinical consequences were present in about a third of lean patients, these were still more common in non-lean NAFLD. Cirrhosis or HCC were already present in a significant proportion (8.4%) of NAFLD patients on initial presentation.
菲律宾关于非酒精性脂肪性肝病（NAFLD）的数据稀缺。我们旨在比较瘦型（BMI<23）与非瘦型（BMI≥23）NAFLD患者的临床和生化特征。
纳入2007年2月至2017年1月在两家门诊肝病诊所经超声诊断为NAFLD的连续患者。排除有大量酒精摄入、脂肪变性的其他原因以及数据不完整的患者。
共纳入663例患者（57.9%为男性）。大多数患者为非瘦型（88.1%），且丙氨酸氨基转移酶（ALT）升高（63%）。初诊时8.4%的患者已出现肝硬化或肝细胞癌（HCC）。伴有乙型肝炎在有和没有肝硬化的患者中同样常见（20.7%对17.5%；p=0.660）或HCC（17.9%对12.8%；p=0.415）。初诊时与HCC/肝硬化相关的独立因素为年龄较大（OR=1.038）、白蛋白低（OR=0.428）、高BARD评分（BMI、AST/ALT比值、2型糖尿病；OR=2.548）以及有症状（OR=1.808）。与瘦型NAFLD患者相比，非瘦型患者更可能较年轻（51.5±14.4对55±14.3；p=0.003）、患有糖尿病（47.9%对29.1%；p=0.002）、高血压（57.5%对38%；p=0.001）、血脂异常（73.1%对54.4%；p=0.001）和代谢综合征（60.3%对30.4%；p<0.0001），代谢参数异常（低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯、尿酸和空腹血糖），且ALT升高（65.2%对46.8%；p=0.002）和AST升高（41.1±29.6对35.3±28.3；p=0.008）。
瘦型NAFLD的比例为11.9%。虽然约三分之一的瘦型患者存在代谢紊乱及其临床后果，但这些在非瘦型NAFLD中仍更常见。相当比例（8.4%）的NAFLD患者初诊时已出现肝硬化或HCC。
