Onwuzo Somtochukwu Stephen, Hitawala Asif Ali, Boustany Antoine, Kumar Prabhat, Almomani Ashraf, Onwuzo Chidera, Monteiro Jessy Mascarenhas, Asaad Imad
Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44111, United States.
Digestive Disease and Hepatology, Cleveland Clinic Foundation Florida, Weston, FI 33331, United States.
World J Hepatol. 2023 Feb 27;15(2):265-273. doi: 10.4254/wjh.v15.i2.265.
Non-alcoholic fatty liver disease (NAFLD) is a global health concern with a prevalence of about 25% amongst United States adults. Its increased prevalence is attributed to increase in patients with obesity and metabolic syndrome, partly due to similar mechanisms of injury. Nephrotic syndrome (NS) is a clinical entity resulting from extensive proteinuria leading to hypoalbuminemia, hyperlipidemia, edema, and other complications. Given its association with hyperlipidemia, there is concern that patients with NS may be at increased risk of NAFLD.
To perform a cross-sectional population-based study to investigate the prevalence and risk factors of NAFLD in patients with NS.
A large multicenter database (Explorys Inc., Cleveland, OH, United States) was utilized for this retrospective cohort study. A cohort of 49700 patients with a diagnosis of "Non-Alcoholic fatty liver disease" using the Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) between 1999-2022 was identified. Inclusion criteria were age ≥ 18 years, presence of NAFLD, presence of NS. There were no specific exclusion criteria. Univariate and multivariate analysis were performed to adjust for multiple risk factors including age, gender, Caucasian race, NS, type II diabetes mellitus, hypothyroidism, dyslipidemia, obesity, metabolic syndrome and chronic kidney disease. Statistical analysis was conducted using R, and for all analyses, a 2-sided value of < 0.05 was considered statistically significant.
Among the 78734750 individuals screened in this database, there were a total of 49700 subjects with NAFLD. In univariate analysis, the odds of having NAFLD in patients with NS, type 2 diabetes mellitus, hypothyroidism, dyslipidemia, obesity, metabolic syndrome and chronic kidney disease were 14.84 [95% confidence interval (95%CI) 13.67-16.10], 17.05 (95%CI 16.78-17.32), 6.99 (95%CI 6.87-7.11), 13.61 (95%CI 13.38-13.84), 19.19 (95%CI 18.89-19.50), 29.09 (95%CI 28.26--29.95), and 9.05 (95%CI 8.88-9.22), respectively. In multivariate analysis, the odds of having NAFLD amongst patients with NS were increased to 1.85 (95%Cl 1.70-2.02), while the odds were also remained high in patients that have type 2 diabetes mellitus [odds ratio (OR) 3.84], hypothyroidism (OR 1.57), obesity (OR 5.10), hyperlipidemia (OR 3.09), metabolic syndrome (OR 3.42) and chronic kidney disease (OR 1.33).
Patients with NS are frequently found to have NAFLD, even when adjusting for common risk factors. Hence, clinicians should maintain a high index of suspicion regarding presence of NAFLD in patients with NS.
非酒精性脂肪性肝病（NAFLD）是一个全球性的健康问题，在美国成年人中的患病率约为25%。其患病率的增加归因于肥胖和代谢综合征患者的增多，部分原因是损伤机制相似。肾病综合征（NS）是一种临床病症，由大量蛋白尿导致低白蛋白血症、高脂血症、水肿及其他并发症。鉴于其与高脂血症的关联，有人担心NS患者患NAFLD的风险可能增加。
进行一项基于人群的横断面研究，以调查NS患者中NAFLD的患病率及危险因素。
本回顾性队列研究使用了一个大型多中心数据库（美国俄亥俄州克利夫兰市的Explorys公司）。确定了1999年至2022年间使用医学临床术语系统命名法（SNOMED-CT）诊断为“非酒精性脂肪性肝病”的49700例患者队列。纳入标准为年龄≥18岁、患有NAFLD、患有NS。无特定排除标准。进行单因素和多因素分析以调整多种危险因素，包括年龄、性别、白种人种族、NS、2型糖尿病、甲状腺功能减退、血脂异常、肥胖、代谢综合征和慢性肾脏病。使用R进行统计分析，所有分析中，双侧P值<0.05被认为具有统计学意义。
在该数据库筛查的78734750例个体中，共有49700例NAFLD患者。单因素分析中，NS、2型糖尿病、甲状腺功能减退、血脂异常、肥胖、代谢综合征和慢性肾脏病患者患NAFLD的比值比分别为14.84[95%置信区间（95%CI）13.67 - 16.10]、17.05（95%CI 16.78 - 17.32）；6.99（95%CI 6.87 - 7.11）、13.61（95%CI 13.38 - 13.84）、19.19（95%CI 18.89 - 19.50）、29.09（95%CI 28.26 - 29.95）和9.05（9%CI 8.88 - 9.22）。多因素分析中，NS患者患NAFLD的比值比增至1.85（95%CI 1.70 - 2.02），而2型糖尿病患者（比值比[OR]3.84）、甲状腺功能减退患者（OR 1.57）、肥胖患者（OR 5.10）、高脂血症患者（OR 3.09）、代谢综合征患者（OR 3.42）和慢性肾脏病患者（OR 1.33）的比值比也仍然较高。
即使调整常见危险因素后，NS患者中也经常发现患有NAFLD。因此，临床医生应对NS患者中NAFLD的存在保持高度怀疑指数。
