NEJM:非酒精性脂肪性肝病成人结局分析

2021-10-21 MedSci原创 MedSci原创

在这项涉及NAFLD患者的前瞻性研究中,纤维化阶段F3和F4与肝脏相关并发症和死亡的风险增加相关。

在非酒精性脂肪性肝病(NAFLD)的组织学范围内,关于死亡率以及肝脏和非肝脏结局的预后尚未明确。

近日,顶级医学期刊NEJM上发表了一篇研究文章,研究人员前瞻性地随访了一个多中心患者群体,其中包括NAFLD的完整组织学图谱。研究人员旨在比较不同基线组织学特征患者死亡和其他结局的发生率。

该研究总共对1773名NAFLD成人进行了中位4年的随访。全因死亡率随着纤维化阶段的增加而增加(F0至F2期每100人每年死亡0.32人[无、轻度或中度纤维化],F3期每100人每年死亡0.89人[桥接纤维化],以及F4期每100人每年死亡1.76人年[肝硬化])。每100人每年肝脏相关并发症的发生率随纤维化分期(F0至F2 vs. F3 vs. F4)而增加,具体如下:静脉曲张出血(0.00 vs. 0.06 vs. 0.70)、腹水(0.04 vs. 0.52 vs. 1.20)、脑病(0.02 vs. 0.75 vs. 2.39)和肝细胞癌(0.04 vs. 0.34 vs. 0.14)。

与F0至F2期纤维化患者相比,F4期纤维化患者2型糖尿病(每100人年7.53次 vs. 4.45次),估计的肾小球滤过率降低40%以上(每100人年2.98 vs. 0.97次事件)的发生率也更高。心脏事件和非肝癌的发生率在各个纤维化阶段相似。在调整年龄、性别、种族、糖尿病状态和基线组织学严重程度后,任何肝脏失代偿事件(静脉曲张出血、腹水或脑病)的发生率都与全因死亡率增加相关(调整后的风险比为6.8;95%置信区间为2.2到21.3)。

在这项涉及NAFLD患者的前瞻性研究中,纤维化阶段F3和F4与肝脏相关并发症和死亡的风险增加相关。

原始出处:
 
Arun J. Sanyal,et al.Prospective Study of Outcomes in Adults with Nonalcoholic Fatty Liver Disease.NEJM.2021.https://www.nejm.org/doi/full/10.1056/NEJMoa2029349

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    2022-09-14 qjddjq
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    2021-10-31 苏小雨

    学习了,不错

    0

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    2021-10-21 ms1000002136354097

    注意脂肪肝的危害

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