Syed Taseen, Chadha Nikita, Kumar Dhiren, Gupta Gaurav, Sterling Richard K
Department of Gastroenterology, Nutrition and Hepatology, Virginia Commonwealth University, Richmond, VA, USA.
Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA.
Gastroenterology Res. 2021 Aug;14(4):244-251. doi: 10.14740/gr1445. Epub 2021 Aug 11.
Non-alcoholic fatty liver disease (NAFLD) has an increased prevalence in end-stage renal disease (ESRD) due to similar risk factors. The aim of this study was to assess non-invasive testing including transient elastography (TE) for liver stiffness (LS), controlled attenuated parameter (CAP) for steatosis, Fibrosis-4 (FIB-4) score, aspartate aminotransferase (AST) to platelet ratio index (APRI) and NAFLD fibrosis score (NFS), for evaluation of NAFLD along with advanced fibrosis (AF) in patients with ESRD undergoing renal transplant evaluation.
Data were retrospectively collected within 12 weeks of TE. Primary outcomes were AF, defined by LS ≥ 9 kPa compared to APRI > 1.5, FIB-4 > 2.67, and NFS of 0.675, and ≥ 5% steatosis by CAP ≥ 263 dB/m compared to liver histology when available.
A total of 171 patients were evaluated: mean age 56, 65% male, 36% obese, 47% had diabetes, 96% hypertension, and 56% dyslipidemia. Mean LS was 6.5 kPa with 21% having AF. Mean CAP was 232 dB/m, with 25% having steatosis. Those with AF were older with higher NFS. Those with steatosis were obese and had diabetes without higher LS or fibrosis scores. Only NFS was associated with LS ≥ 9 kPa. In those with liver histology, AF was associated with LS ≥ 9 kPa but not with APRI, FIB-4, or NFS.
Despite normal liver enzymes, non-invasive assessment via TE in ESRD patients exhibited high prevalence of AF and steatosis not detected by APRI or FIB-4 scores. This high prevalence was secondary to the common risk factors such as obesity and diabetes, among patients with NAFLD and ESRD.
由于存在相似的危险因素，非酒精性脂肪性肝病（NAFLD）在终末期肾病（ESRD）中的患病率有所增加。本研究的目的是评估包括用于检测肝脏硬度（LS）的瞬时弹性成像（TE）、用于检测脂肪变性的受控衰减参数（CAP）、Fibrosis-4（FIB-4）评分、天冬氨酸转氨酶（AST）与血小板比值指数（APRI）以及NAFLD纤维化评分（NFS）等非侵入性检测方法，以评估接受肾移植评估的ESRD患者的NAFLD及晚期纤维化（AF）情况。
在TE检查的12周内回顾性收集数据。主要结局指标为AF，其定义为与APRI>1.5、FIB-4>2.67和NFS为0.675相比，LS≥9 kPa，以及与可用的肝脏组织学检查相比，CAP≥263 dB/m时脂肪变性≥5%。
共评估了171例患者：平均年龄56岁，65%为男性，36%肥胖，47%患有糖尿病，96%患有高血压，56%患有血脂异常。平均LS为6.5 kPa，21%的患者有AF。平均CAP为232 dB/m，25%的患者有脂肪变性。有AF的患者年龄较大且NFS较高。有脂肪变性的患者肥胖且患有糖尿病，但LS或纤维化评分不高。只有NFS与LS≥9 kPa相关。在有肝脏组织学检查的患者中，AF与LS≥9 kPa相关，但与APRI、FIB-4或NFS无关。
尽管肝酶正常，但ESRD患者通过TE进行的非侵入性评估显示，AF和脂肪变性的患病率很高，而APRI或FIB-4评分未检测到这些情况。这种高患病率是NAFLD和ESRD患者中肥胖和糖尿病等常见危险因素导致的。
