Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea.
MEDIcheck LAB, Korea Association of Health Promotion, Seoul, Korea.
PLoS One. 2021 Nov 24;16(11):e0260477. doi: 10.1371/journal.pone.0260477. eCollection 2021.
Nonalcoholic steatohepatitis (NASH) has a risk of progressing to cirrhosis. The prevalence of NASH and its associated risk factors in community populations are relatively unknown. This study aimed to determine the prevalence of NASH and advanced liver fibrosis using magnetic resonance elastography (MRE), and determine those risk factors in health examinees with asymptomatic fatty liver.
This study consecutively selected subjects who underwent health checkups at 13 health-promotion centers in 10 Korean cities between 2018 and 2020. Hepatic steatosis and stiffness were assessed using ultrasonography and MRE, respectively. Stages of liver stiffness were estimated using MRE with cutoff values for NASH and advanced liver fibrosis of 2.91 and 3.60 kPa, respectively.
The overall prevalence of NASH and advanced liver fibrosis in the subjects with fatty liver were 8.35% and 2.04%, respectively. Multivariate logistic regression analysis indicated that central obesity (OR = 5.12, 95% CI = 2.70-9.71), increased triglyceride (OR = 3.29, 95% CI = 1.72-6.29), abnormal liver function test (OR = 3.09, 95% CI = 1.66-5.76) (all P<0.001), and decreased high-density lipoprotein cholesterol (OR = 5.18, 95% CI = 1.78-15.05) (P = 0.003) were associated with NASH. The main risk factor for advanced liver fibrosis was diabetes (OR = 4.46, 95% CI = 1.14-17.48) (P = 0.032).
NASH or advanced liver fibrosis is found in one-tenth of health examinees with asymptomatic fatty liver. This suggests that early detection of NASH should be considered to allow early interventions such as lifestyle changes to prevent the adverse effects of NASH and its progression in health examinees with asymptomatic fatty liver.
非酒精性脂肪性肝炎（NASH）有进展为肝硬化的风险。社区人群中 NASH 的患病率及其相关危险因素相对未知。本研究旨在使用磁共振弹性成像（MRE）确定无症状性脂肪肝体检者中 NASH 和进展性肝纤维化的患病率，并确定这些危险因素。
本研究连续选择了 2018 年至 2020 年间在韩国 10 个城市的 13 个健康促进中心进行健康检查的受试者。使用超声和 MRE 分别评估肝脂肪变性和肝硬度。使用 MRE 估计肝硬度分期，NASH 和进展性肝纤维化的截断值分别为 2.91kPa 和 3.60kPa。
脂肪肝受试者中 NASH 和进展性肝纤维化的总患病率分别为 8.35%和 2.04%。多变量 logistic 回归分析表明，中心性肥胖（OR=5.12，95%CI=2.70-9.71）、甘油三酯升高（OR=3.29，95%CI=1.72-6.29）、肝功能异常（OR=3.09，95%CI=1.66-5.76）（均 P<0.001）和高密度脂蛋白胆固醇降低（OR=5.18，95%CI=1.78-15.05）（P=0.003）与 NASH 相关。进展性肝纤维化的主要危险因素是糖尿病（OR=4.46，95%CI=1.14-17.48）（P=0.032）。
在无症状性脂肪肝体检者中，有十分之一的人患有 NASH 或进展性肝纤维化。这表明，对于无症状性脂肪肝体检者，应考虑早期发现 NASH，以便进行生活方式改变等早期干预，从而预防 NASH 的不良影响及其进展。
