Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.
Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan; Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Nutr Metab Cardiovasc Dis. 2024 Sep;34(9):2115-2123. doi: 10.1016/j.numecd.2024.03.025. Epub 2024 Mar 27.
Patients with nonalcoholic fatty liver disease (NAFLD) have a higher risk of cardiac events. However, although the severity of liver fibrosis is related to worsening prognosis in patients with NAFLD, it is unclear whether the noninvasive liver fibrosis score has a predictive value for cardiac events.
We evaluated 4071 patients with NAFLD diagnosed using ultrasonography. Liver fibrosis was assessed and divided into three groups based on the Fibrosis-4 (FIB4) index and NAFLD fibrosis score (NFS). The primary outcome of this study was major adverse cardiac events (MACE), including cardiac death, nonfatal myocardial infarction, and revascularization due to coronary artery disease. The median age of the evaluated patients was 61 (52-69) years, and 2201 (54.1%) were male. During the median follow-up period of 6.6 years, 179 (4.4%) patients experienced MACE. Kaplan-Meier survival analysis demonstrated that MACE increased progressively with the FIB4 index (log-rank, p < 0.001) and NFS (log-rank, p < 0.001). Multivariable analysis showed that the higher the FIB4 index, the higher the risk for MACE (low group as reference vs. intermediate group, hazard ratio [HR]: 1.860 [95% confidence interval (CI), 1.326-2.610; p < 0.001]; vs. high group, HR:3.325 [95% CI, 2.017-5.479; p < 0.001]), as well as NFS (low NFS group as reference vs. intermediate group, HR: 1.938 [95% CI, 1.391-2.699; p < 0.001]; vs. high group, HR: 3.492 [95% CI, 1.997-6.105; p < 0.001]).
The FIB4 index and NFS are associated with the probability of MACE in patients with NAFLD.
The study design was approved by the ethics review board of Ogaki Municipal Hospital (approval number: 20221124-12, registration date: November 28th, 2022). https://www.ogaki-mh.jp/chiken/kenkyu.html.
非酒精性脂肪性肝病（NAFLD）患者发生心脏事件的风险较高。然而，尽管肝纤维化的严重程度与 NAFLD 患者的预后恶化有关，但非侵入性肝纤维化评分是否对心脏事件具有预测价值尚不清楚。
我们评估了 4071 名通过超声诊断的 NAFLD 患者。评估了肝纤维化，并根据纤维化 4 指数（FIB4）和非酒精性脂肪性肝病纤维化评分（NFS）将其分为三组。本研究的主要终点是主要不良心脏事件（MACE），包括心脏死亡、非致死性心肌梗死和因冠状动脉疾病进行的血运重建。评估患者的中位年龄为 61（52-69）岁，2201 名（54.1%）为男性。在中位随访 6.6 年期间，179 名（4.4%）患者发生了 MACE。Kaplan-Meier 生存分析表明，MACE 随着 FIB4 指数的增加而逐渐增加（对数秩检验，p<0.001）和 NFS（对数秩检验，p<0.001）。多变量分析显示，FIB4 指数越高，MACE 的风险越高（低组作为参考与中组相比，危险比[HR]：1.860[95%置信区间（CI），1.326-2.610；p<0.001]；与高组相比，HR：3.325[95%CI，2.017-5.479；p<0.001]），以及 NFS（低 NFS 组作为参考与中组相比，HR：1.938[95%CI，1.391-2.699；p<0.001]；与高组相比，HR：3.492[95%CI，1.997-6.105；p<0.001]）。
FIB4 指数和 NFS 与 NAFLD 患者 MACE 的发生概率相关。
该研究设计已获得大垣市立医院伦理审查委员会的批准（批准号：20221124-12，注册日期：2022 年 11 月 28 日）。https://www.ogaki-mh.jp/chiken/kenkyu.html。
