University of Health Sciences, Haydarpasa Numune Research and Training Hospital, Department of Nephrology and Transplantation, Istanbul, Turkey.
Cerrahpasa Medical Faculty of Istanbul University Cerrahpasa, Department of Gastroenterology, Istanbul, Turkey.
Arab J Gastroenterol. 2023 Feb;24(1):52-57. doi: 10.1016/j.ajg.2023.01.001. Epub 2023 Feb 8.
Non-alcoholic fatty liver disease (NAFLD) is an independent risk factor for chronic kidney disease (CKD). Previous studies argued that leptin levels increase significantly with the progression of CKD. But the association between leptin and CKD has not been investigated in patients with NAFLD. Therefore, we conducted this study to establish whether increased leptin level is associated with CKD in NAFLD patients.
In our prospective study with a follow up period of six months thirty-five teetotaller biopsy-proven NAFLD patients were divided as groups with mild, versus advanced, fibrosis. Liver fibrosis was also assessed with Fibroscan. Serum leptin levels were measured by radioimmunoassay. For insulin resistance we used the homeostasis model assessment method (HOMA-IR). For the kidney function, we used the abbreviated formula Modification of Diet in Renal Disease (MDRD) formula, which estimates GFR. For statistical analysis, Student's-t test, Mann-Whitney test, linear regression-binary logistic regression analyses and the ROC curve analysis were used.
Advanced fibrosis and increased HOMA-IR were risk factors for decreased eGFR. Leptin correlated inversely with advanced fibrosis (p: 0.03) and low leptin was a risk factor for CKD (p: 0.02). In ROC curve analysis, advanced fibrosis and low leptin were risk factors for decreased eGFR (p: 0.007 and 0.004, respectively). Low leptin level was dependently associated with decreased eGFR.
Advanced fibrosis in NAFLD patients is a risk factor for CKD. Leptin correlated inversely with advanced fibrosis. Unlike the previous studies, which were not performed in NAFLD patients, we found decreased leptin in NAFLD patients with decreased eGFR. Low leptin level was found to be a dependent predictor for differentiating NAFLD patients with high risk for CKD.
非酒精性脂肪性肝病（NAFLD）是慢性肾脏病（CKD）的独立危险因素。先前的研究表明，瘦素水平随着 CKD 的进展而显著升高。但是，在 NAFLD 患者中，瘦素与 CKD 之间的关系尚未得到研究。因此，我们进行了这项研究，以确定 NAFLD 患者中升高的瘦素水平是否与 CKD 相关。
在我们进行的前瞻性研究中，对 35 名戒酒活检证实的 NAFLD 患者进行了为期六个月的随访，将其分为纤维化程度较轻和纤维化程度较重的两组。使用 Fibroscan 评估肝纤维化。通过放射免疫测定法测量血清瘦素水平。使用稳态模型评估法（HOMA-IR）评估胰岛素抵抗。对于肾功能，我们使用简化的肾脏病饮食改良公式（MDRD）公式，该公式估计 GFR。对于统计分析，使用学生 t 检验，Mann-Whitney 检验，线性回归-二项逻辑回归分析和 ROC 曲线分析。
晚期纤维化和增加的 HOMA-IR 是 eGFR 降低的危险因素。瘦素与晚期纤维化呈负相关（p：0.03），低瘦素是 CKD 的危险因素（p：0.02）。在 ROC 曲线分析中，晚期纤维化和低瘦素是 eGFR 降低的危险因素（p：0.007 和 0.004）。低瘦素水平与 eGFR 降低有依赖性关联。
NAFLD 患者的晚期纤维化是 CKD 的危险因素。瘦素与晚期纤维化呈负相关。与先前未在 NAFLD 患者中进行的研究不同，我们发现 NAFLD 患者中 eGFR 降低与瘦素降低有关。低瘦素水平是区分 NAFLD 患者中 CKD 高危患者的独立预测因子。
