Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; Università Cattolica del Sacro Cuore Rome, 00168 Rome, Italy.
Department of Medicine III, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany; Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.
Diabetes Metab. 2022 Sep;48(5):101363. doi: 10.1016/j.diabet.2022.101363. Epub 2022 Jun 24.
To investigate the prevalence of biopsy-proven non-alcoholic steatohepatitis (NASH) in a cohort of patients with morbid obesity and with or without type 2 diabetes (T2D) and to find non-invasive predictors of NASH severity.
We evaluated a cohort of 412 subjects (age 19-67 years, body mass index-BMI: 44.98 kg/m), who underwent fine-needle liver biopsy during bariatric surgery. Thirty-six percent of the subjects were affected by T2D. Liver biopsies were classified according to the Kleiner's NAFLD Activity Score (NAS). NAFLD Fibrosis Score (NFS), AST/ALT ratio, AST to Platelet ratio (APRI), fibrosis-4 score (FIB4) were calculated. A neural network analysis (NNA) was run to predict NASH severity.
The prevalence of biopsy-proven NASH was 63% and 78% in subjects with obesity and without or with T2D, respectively. T2D doubled the risk of NASH [OR 2.079 (95% IC=1.31-3.29)]. The prevalence of NAFL increased with the increase of BMI, while there was an inverse correlation between BMI and NASH (r=-0.145 p=0.003). Only mild liver fibrosis was observed. HOMA-IR was positively associated with hepatocyte ballooning (r=0.208, p<0.0001) and fibrosis (r=0.159, p=0.008). The NNA highlighted a specificity of 77.3% using HDL-cholesterol, BMI, and HOMA-IR as main determinants of NASH.
Our data show a higher prevalence of NASH in patients with morbid obesity than reported in the literature and the pivotal role of T2D among the risk factors for NASH development. However, the inverse correlation observed between BMI and biopsy-proven NASH suggests that over a certain threshold adiposity can be somewhat protective against liver damage. Our model predicts NASH presence with high specificity, thus helping identifying subjects who should promptly undergo liver biopsy.
调查肥胖症患者（BMI≥40kg/m2）中经活检证实的非酒精性脂肪性肝炎（NASH）的患病率，以及合并或不合并 2 型糖尿病（T2D）患者中的患病率，并寻找 NASH 严重程度的非侵入性预测因子。
我们评估了 412 名患者（年龄 19-67 岁，BMI：44.98kg/m2）的队列，这些患者在接受减重手术期间接受了细针肝活检。36%的患者患有 T2D。根据 Kleiner 的非酒精性脂肪性肝病活动评分（NAS）对肝活检进行分类。计算了非酒精性脂肪性肝病纤维化评分（NFS）、AST/ALT 比值、AST 与血小板比值（APRI）、纤维化 4 评分（FIB4）。进行了神经网络分析（NNA）以预测 NASH 严重程度。
在肥胖症且无或合并 T2D 的患者中，活检证实的 NASH 患病率分别为 63%和 78%。T2D 使 NASH 的风险增加了两倍[OR 2.079（95%CI=1.31-3.29）]。NAFL 的患病率随 BMI 的增加而增加，而 BMI 与 NASH 呈负相关（r=-0.145，p=0.003）。仅观察到轻度肝纤维化。HOMA-IR 与肝细胞气球样变（r=0.208，p<0.0001）和纤维化（r=0.159，p=0.008）呈正相关。NNA 突出了使用 HDL-胆固醇、BMI 和 HOMA-IR 作为 NASH 主要决定因素的情况下，NASH 特异性为 77.3%。
我们的数据显示，与文献报道相比，肥胖症患者的 NASH 患病率更高，并且 T2D 是 NASH 发展的危险因素之一。然而，BMI 与活检证实的 NASH 之间的负相关表明，超过一定阈值的肥胖症可能对肝脏损伤有一定的保护作用。我们的模型以高特异性预测 NASH 的存在，从而有助于识别应及时进行肝活检的患者。
