UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, United Kingdom.
Nottingham Digestive Diseases Centre, Queen's Medical Centre, Nottingham, United Kingdom.
Clin Gastroenterol Hepatol. 2023 Nov;21(12):3107-3114.e3. doi: 10.1016/j.cgh.2023.04.018. Epub 2023 Apr 30.
BACKGROUND & AIMS: It is unclear whether health-related quality of life (HRQoL) is impaired in patients with nonalcoholic fatty liver disease (NAFLD) without advanced fibrosis and how this compares with the general population. We aimed to assess HRQoL in patients with NAFLD in comparison to the general population and any associations of fibrosis severity and metabolic comorbidities with impairments in HRQoL.
We prospectively enrolled 513 consecutive patients with NAFLD who completed the EuroQol 5-dimensional questionnaire (EQ-5D) and Chronic Liver Disease Questionnaires (CLDQ). Demographic and clinical information, liver biopsy results, and/or liver stiffness (LS) by transient elastography were recorded. A general population sub-cohort of the Health Survey for England 2018 was used as a comparator (n = 5483), and a 1:1 propensity-score (PS) matching was performed, according to age, sex, body mass index, and type 2 diabetes mellitus (T2DM).
EQ-5D-5L utility was significantly lower in 466 PS-matched patients with NAFLD compared with PS-matched controls (0.77 ± 0.27 vs 0.84 ± 0.19; P < .001), even in those without advanced fibrosis (F ≤2 or LS <8kPa) (0.80 ± 0.24 vs 0.84 ± 0.19; P = .024). HRQoL measures (EQ-5D-5L, EQ-VAS, CLDQ) did not differ between patients with NAFLD with and without advanced fibrosis. LS was independently associated with lower EQ-5D-5L in all patients with NAFLD but not in those without advanced fibrosis. In the latter, lower EQ-5D-5L was associated with female sex, T2DM, and depression.
Patients with NAFLD, even those without advanced fibrosis, have worse HRQoL compared with the general population. In patients with NAFLD without advanced fibrosis, HRQoL is independently associated with non-liver comorbidities but not LS. Multi-disciplinary management is therefore required in NAFLD, irrespective of fibrosis severity.
非酒精性脂肪性肝病（NAFLD）患者即使无晚期纤维化，其健康相关生活质量（HRQoL）是否受损尚不清楚，且与普通人群相比如何也并不清楚。本研究旨在评估 NAFLD 患者的 HRQoL，并与普通人群进行比较，同时评估纤维化严重程度和代谢合并症与 HRQoL 受损的相关性。
我们前瞻性纳入了 513 例连续的 NAFLD 患者，这些患者完成了欧洲五维健康量表（EQ-5D）和慢性肝病问卷（CLDQ）的评估。记录了人口统计学和临床信息、肝活检结果和/或通过瞬时弹性成像检测到的肝硬度（LS）。使用 2018 年英格兰健康调查的一般人群亚组作为对照（n=5483），并根据年龄、性别、体重指数和 2 型糖尿病（T2DM）进行了 1:1 倾向评分（PS）匹配。
在 466 例 PS 匹配的 NAFLD 患者中，EQ-5D-5L 效用显著低于 PS 匹配的对照组（0.77±0.27 vs 0.84±0.19；P<.001），即使在无晚期纤维化（F≤2 或 LS<8kPa）的患者中也是如此（0.80±0.24 vs 0.84±0.19；P=.024）。HRQoL 指标（EQ-5D-5L、EQ-VAS、CLDQ）在有或无晚期纤维化的 NAFLD 患者之间没有差异。在所有 NAFLD 患者中，LS 与较低的 EQ-5D-5L 独立相关，但在无晚期纤维化的患者中并非如此。在后一组中，较低的 EQ-5D-5L 与女性、T2DM 和抑郁有关。
即使无晚期纤维化，NAFLD 患者的 HRQoL 也较普通人群差。在无晚期纤维化的 NAFLD 患者中，HRQoL 与非肝脏合并症独立相关，而与 LS 无关。因此，无论纤维化严重程度如何，NAFLD 都需要多学科管理。
