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非酒精性脂肪性肝病患者阻塞性睡眠呼吸暂停综合征的风险与肥胖和 NASH 的存在有关。

OBSTRUCTIVE SLEEP APNEA SYNDROME RISK IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE IS ASSOCIATED WITH OBESITY AND PRESENCE OF NASH.

机构信息

Universidade Federal de São Paulo, Departamento de Medicina, Disciplina de Gastroenterologia, São Paulo, SP, Brasil.

Universidade Federal de São Paulo, Departamento de Medicina, Disciplina de Nefrologia, São Paulo, SP, Brasil.

出版信息

Arq Gastroenterol. 2022 Apr-Jun;59(2):251-256. doi: 10.1590/S0004-2803.202202000-45.

Abstract

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is the most common form of liver disease and refers to a wide spectrum of histological abnormalities ranging from simple steatosis (HE) to non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis and hepatocellular carcinoma.

OBJECTIVE

To assess the risk of obstructive sleep apnea syndrome (OSAS) and relating it to demographic, biochemical and histological data in patients with non-alcoholic fatty liver disease.

METHODS

Cross-sectional cohort study in individuals with biopsy-proven NAFLD. Anthropometric and biochemical parameters, presence of metabolic syndrome and insulin resistance were evaluated. The Berlin Questionnaire (BQ) was applied to assess the risk of apnea and a food record was requested. Based on the BQ, participants were classified as high or low risk for OSAS. In the correlation of sleep apnea with the severity of NAFLD, presence of nonalcoholic steatohepatitis (NASH) and the degree of liver fibrosis were evaluated. Statistical analysis used the chi-square test, Student's t and bivariate logistic regression; values were expressed as mean ± standard deviation. This research project was approved by the Ethics Committee.

RESULTS

Regarding the parameters evaluated, significant differences were observed between the groups in terms of body mass index (BMI), waist and neck circumference. In the histological evaluation, patients classified as high risk were more likely to have fibrosis and NASH. In bivariate regression, the BMI, presence of fibrosis and steatohepatitis in the biopsy were independently associated with an elevated risk of the syndrome.

CONCLUSION

A high prevalence of risk for OSAS was observed in the studied group, with a higher risk being independently associated with BMI and presence of steatohepatitis, suggesting that it is a factor associated with the severity of the disease.

摘要

背景

非酒精性脂肪性肝病(NAFLD)是最常见的肝病形式,是指从单纯性脂肪变性(HE)到非酒精性脂肪性肝炎(NASH)、纤维化、肝硬化和肝细胞癌等广泛的组织学异常。

目的

评估非酒精性脂肪性肝病患者阻塞性睡眠呼吸暂停综合征(OSAS)的风险,并将其与人口统计学、生化和组织学数据相关联。

方法

对经活检证实的非酒精性脂肪性肝病患者进行横断面队列研究。评估了人体测量学和生化参数、代谢综合征和胰岛素抵抗的存在情况。应用柏林问卷(BQ)评估了呼吸暂停的风险,并要求记录饮食情况。根据 BQ,将参与者分为 OSAS 高风险或低风险组。在睡眠呼吸暂停与非酒精性脂肪性肝病严重程度、非酒精性脂肪性肝炎(NASH)的存在和肝纤维化程度的相关性评估中。统计分析采用卡方检验、学生 t 检验和双变量逻辑回归;值表示为平均值±标准差。本研究项目获得了伦理委员会的批准。

结果

就评估的参数而言,两组在体重指数(BMI)、腰围和颈围方面存在显著差异。在组织学评估中,被归类为高风险的患者更有可能出现纤维化和 NASH。在双变量回归中,BMI、活检中纤维化和脂肪性肝炎的存在与该综合征风险升高独立相关。

结论

在所研究的组中观察到 OSAS 风险的高患病率,风险增加与 BMI 和脂肪性肝炎的存在独立相关,表明这是与疾病严重程度相关的一个因素。

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