非酒精性脂肪性肝病（NAFLD）和非酒精性脂肪性肝炎（NASH）的全球流行病学：系统评价。
The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review.
机构信息
Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA.
Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, Virginia, USA.
出版信息
Hepatology. 2023 Apr 1;77(4):1335-1347. doi: 10.1097/HEP.0000000000000004. Epub 2023 Jan 3.
BACKGROUND AND AIMS
NAFLD is a leading cause of liver-related morbidity and mortality. We assessed the global and regional prevalence, incidence, and mortality of NAFLD using an in-depth meta-analytic approach.
APPROACH AND RESULTS
PubMed and Ovid MEDLINE were searched for NAFLD population-based studies from 1990 to 2019 survey year (last published 2022) per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Meta-analysis was conducted using random-effects models. Bias risk assessment was per Joanna Briggs Institute. Of 2585 studies reviewed, 92 studies (N=9,361,716) met eligibility criteria. Across the study period (1990-2019), meta-analytic pooling of NAFLD prevalence estimates and ultrasound-defined NAFLD yielded an overall global prevalence of 30.05% (95% CI: 27.88%-32.32%) and 30.69% (28.4-33.09), respectively. Global NAFLD prevalence increased by +50.4% from 25.26% (21.59-29.33) in 1990-2006 to 38.00% (33.71-42.49) in 2016-2019 ( p <0.001); ultrasound-defined NAFLD prevalence increased by +38.7% from 25.16% (19.46-31.87) in 1990-2006 to 34.59% (29.05-40.57) ( p =0.029). The highest NAFLD prevalence was in Latin America 44.37% (30.66%-59.00%), then Middle East and North Africa (MENA) (36.53%, 28.63%-45.22%), South Asia (33.83%, 22.91%-46.79%), South-East Asia (33.07%, 18.99%-51.03%), North America (31.20%, 25.86%-37.08%), East Asia (29.71%, 25.96%-33.76%), Asia Pacific 28.02% (24.69%-31.60%), Western Europe 25.10% (20.55%-30.28%). Among the NAFLD cohort diagnosed without a liver biopsy, pooled mortality rate per 1000 PY was 12.60 (6.68-23.67) for all-cause mortality; 4.20 (1.34-7.05) for cardiac-specific mortality; 2.83 (0.78-4.88) for extrahepatic cancer-specific mortality; and 0.92 (0.00-2.21) for liver-specific mortality.
CONCLUSIONS
NAFLD global prevalence is 30% and increasing which requires urgent and comprehensive strategies to raise awareness and address all aspects of NAFLD on local, regional, and global levels.
背景与目的
非酒精性脂肪性肝病（NAFLD）是导致与肝脏相关的发病率和死亡率的主要原因。我们采用深入的荟萃分析方法评估了全球和区域范围内 NAFLD 的流行率、发病率和死亡率。
方法和结果
通过系统评价和荟萃分析的首选报告项目（PRISMA），从 1990 年至 2019 年调查年份（最近一次发表于 2022 年）的人群为基础的 NAFLD 研究中检索 PubMed 和 Ovid MEDLINE。采用随机效应模型进行荟萃分析。偏倚风险评估按照乔安娜·布里格斯研究所的标准进行。在审查的 2585 项研究中，有 92 项研究（N=9361716）符合入选标准。在整个研究期间（1990-2019 年），NAFLD 流行率估计值和超声定义的 NAFLD 的荟萃分析汇总结果显示，全球范围内的总体流行率分别为 30.05%（95%CI：27.88%-32.32%）和 30.69%（28.4-33.09%）。全球范围内的 NAFLD 流行率从 1990-2006 年的 25.26%（21.59-29.33%）增加到 2016-2019 年的 38.00%（33.71-42.49%）（p<0.001）；超声定义的 NAFLD 流行率从 1990-2006 年的 25.16%（19.46-31.87%）增加到 34.59%（29.05-40.57%）（p=0.029）。NAFLD 流行率最高的地区是拉丁美洲（44.37%，30.66%-59.00%），其次是中东和北非（MENA）（36.53%，28.63%-45.22%）、南亚（33.83%，22.91%-46.79%）、东南亚（33.07%，18.99%-51.03%）、北美（31.20%，25.86%-37.08%）、东亚（29.71%，25.96%-33.76%）、亚太地区（28.02%，24.69%-31.60%）、西欧（25.10%，20.55%-30.28%）。在未经肝活检诊断的 NAFLD 队列中，每 1000 人年的总死亡率为 12.60（6.68-23.67）；心脏特异性死亡率为 4.20（1.34-7.05）；肝外癌症特异性死亡率为 2.83（0.78-4.88）；肝特异性死亡率为 0.92（0.00-2.21）。
结论
全球范围内的 NAFLD 流行率为 30%，并且还在不断上升，这需要在地方、区域和全球各级紧急制定和实施全面的战略，以提高对 NAFLD 的认识并解决其各个方面的问题。
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