非酒精性脂肪性肝病进展性肝纤维化危险因素分析
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摘要
目的分析非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)患者肝纤维化危险因素。方法选取新疆医科大学附属中医医院2016年6月至2017年6月就诊的NAFLD患者进行横断面分析,根据Fibro Touch所检测的肝弹性值将209例患者分为无或轻度肝纤维化组(n=112)及进展性肝纤维化组(n=97)。运用Spearman相关分析、Logistic回归分析可能发生肝纤维化的影响因素。结果两组患者在BMI、肝弹性值、CAP、ALT、AST、TG、Ins之间差异有统计学意义(P <0. 05)。各研究因素与肝纤维化相关性分析显示,脂肪肝肝纤维化与年龄、BMI、ALT、AST、TG、CAP、Ins呈正相关(P <0. 05)。非条件二分类变量Logistic回归分析显示,BMI、CAP、ALT、TG、Ins是NAFLD进展性肝纤维化的独立危险因素(P均<0. 05)。结论肥胖、血脂异常、胰岛素抵抗等代谢危险因素增加NAFLD患者肝纤维化的发生风险,与纤维化进展相关。
Objective To investigate the risk factors of liver fibrosis in nonalcoholic fatty liver disease( NAFLD)patients. Methods A cross-sectional analysis was performed on NAFLD patients form Jun. 2016 to Jun. 2017 in the Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University. Aaccording to the liver elasticity measured by FibroTouch,209 patients were divided into no or mild hepatic fibrosis group( n = 112) and progressive liver fibrosis group( n = 97). Spearman correlation analysis and Logistic regression analysis were used to analyze the factors influencing liver fibrosis. Results There were significant differences in BMI,liver elasticity,CAP,ALT,AST,TG,Ins between two groups( P < 0. 05). Correlation analysis between each factor and hepatic fibrosis showed that fatty liver fibrosis was positively related with age,BMI,ALT,AST,TG,CAP and Ins( P < 0. 05). Logistic regression analysis showed that BMI,CAP,ALT,TG and Ins were independent risk factors of NAFLD progression of hepatic fibrosis( all P < 0. 05). Conclusion Metabolic risk factors such as obesity,dyslipidemia and insulin resistance increase the risk of hepatic fibrosis in patients with NAFLD and they are related to the progress of fibrosis.
Objective To investigate the risk factors of liver fibrosis in nonalcoholic fatty liver disease( NAFLD)patients. Methods A cross-sectional analysis was performed on NAFLD patients form Jun. 2016 to Jun. 2017 in the Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University. Aaccording to the liver elasticity measured by FibroTouch,209 patients were divided into no or mild hepatic fibrosis group( n = 112) and progressive liver fibrosis group( n = 97). Spearman correlation analysis and Logistic regression analysis were used to analyze the factors influencing liver fibrosis. Results There were significant differences in BMI,liver elasticity,CAP,ALT,AST,TG,Ins between two groups( P < 0. 05). Correlation analysis between each factor and hepatic fibrosis showed that fatty liver fibrosis was positively related with age,BMI,ALT,AST,TG,CAP and Ins( P < 0. 05). Logistic regression analysis showed that BMI,CAP,ALT,TG and Ins were independent risk factors of NAFLD progression of hepatic fibrosis( all P < 0. 05). Conclusion Metabolic risk factors such as obesity,dyslipidemia and insulin resistance increase the risk of hepatic fibrosis in patients with NAFLD and they are related to the progress of fibrosis.
引文
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[10] STL P. Liver fibrosis in non-alcoholic fatty liver disease-diagnostic challenge with prognostic significance[J]. World J Gastroenterol,2015,21(39):11077-11087. DOI:10. 3748/wjg. v21. i39. 11077.
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[12] ROSSO C,MEZZABOTTA L,GAGGINI M,et al. Periperal insulin resistance predicts liver damage in nondiabetic subjects with nonalcoholic fatty liver disease[J]. Hepatology,2016,63(1):107-116.DOI:10. 1002/hep. 28287.
[13]柳涛,张莉,范建高,等.《2016年英国国家卫生与临床优化研究所非酒精性脂肪性肝病的评估和管理指南》摘译[J].临床肝胆病杂志,2016,32(11):2036-2038. DOI:10. 3969/j. issn.1001-5256. 2016. 11. 003.LIU T,ZHANG L,FAN J G,et al. An excerpt of non-alcoholic fatty liver disease(NAFLD):assessment and management(NICE guidelines in 2016[J]. J Clin Hepatol,2016,32(11):2036-2018.DOI:10. 3969/j. issn. 1001-5256. 2016. 11. 003.
[14]侯飞飞,祁兴顺,郭晓钟.《2015年美国超声放射医师学会共识声明:弹性成像评估肝纤维化》摘译[J].临床肝胆病杂志,2015,31(9):1384-1388. DOI:10. 3969/j. issn. 1001-5256. 2015. 09. 005.HOU F F,QI X S,GUO X Z. Elastography assessment of liver fibrosis:society of radiologists in ultrasound consensus conference statement[J].J Clin Hepatol,2015,31(9):1384-1388. DOI:10. 3969/j. issn.1001-5256. 2015. 09. 005.
[15]林晓玲,邓超文,胡国信.《2017年美国胃肠病学会指南:弹性成像检查在评估肝纤维化中的作用》摘译[J].临床肝胆病杂志,2017,33(10):1895-1897. DOI:10. 3969/j. issn. 1001-5256.2017. 10. 009.LIN X L,DENG C W,HU G X. An excerpt of American gastroenterological association institute guideline on the role of elastography in the evaluation of liver fibrosis(2017)[J]. J Clin Hepatol,2017,33(10):1895-1897. DOI:10. 3969/j. issn. 1001-5256. 2017.10. 009.
[16]庄小芳,马燕,王晓忠,等. 3种无创诊断技术对慢性乙型肝炎肝纤维化的评估价值比较[J].临床肝胆病杂志,2016,32(8):1508-1512. DOI:10. 3969/j. issn. 1001-5256. 2016. 08. 015.ZHUANG X F,MA Y,WANG X Z,et al. The predictive values of three noninvasive indices in diagnosis of liver fibrosis in patients with chronic hepatitis B:a comparative study[J]. J Clin Hepatol,2016,32(8):1508-1512. DOI:10. 3969/j. issn. 1001-5256. 2016.08. 015.
[17] MOTAMED N,SOHRABI M,AJDARKOSH H,et al. Fatty liver index vs waist circumference for predicting non-alcoholic fatty liver disease[J]. World J Gastroenterol,2016,22(10):3023-3030.DOI:10. 3748/wjg. v22. i10. 3023.
[18] BIRJANDI M,AYATOLLAHI S M,POURAHMAD S,et al. Prediction and diagnosis of non-alcoholic fatty liver disease(NAFLD)and identification of its associated factors using the classification tree method[J]. Iran Red Crescent Med J,2016,18(11):e32858.DOI:10. 5812/ircmj. 32858.
[19]丁玉平,张文,夏时海,等.非酒精性脂肪性肝病生化特点及其与相关疾病的关系[J].胃肠病学和肝病学杂志,2018,27(8):936-941. DOI:10. 3969/j. issn. 1006-5709. 2018. 08. 023.DING Y P,ZHANG W,XIA S H,et al. Biochemical characteristics of nonalcoholic fatty liver disease and its association with other related diseases[J]. Chin J Gastroenterol Hepatol,2018,27(8):936-941.DOI:10. 3969/j. issn. 1006-5709. 2018. 08. 023.
[20] FRACANZANI A L,PETTA S,LOMBARDI R,et al. Liver and cardiovascular damage in patients with lean nonalcoholic fatty liver disease,and association with visceral obesity[J]. Clin Gastroenterol Hepatol,2017,15(10):1604-1611. DOI:10. 1016/j. cgh. 2017.04. 045.
[20]龚先琼,李珊珊,陈少彬,等. ALT、AST、UA与非酒精性脂肪肝病理的相关性研究[J].医学研究杂志,2016,45(8):90-93.DOI:10. 11969/j. issn. 1673-548X. 2016. 08. 024.GONG X Q,LI S S,CHEN S B,et al. Relationship between ALT,AST and UA levels and liver histology in patients with nonalcoholic fatty liver disease[J]. J Med Res,2016,45(8):90-93. DOI:10.11969/j. issn. 1673-548X. 2016. 08. 024.
[2] YOUNOSSI Z M,KOENIG A B,ABDELATIF D,et al. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence,incidence,and outcomes[J]. Hepatology,2016,64(1):73-84. DOI:10. 1002/hep. 28431.
[3]中华医学会肝脏病学分会脂肪肝和酒精性肝病学组.非酒精性脂肪性肝病诊疗指南[J].中国肝脏病杂志(电子版),2010,2(4):43-48. DOI:10. 3969/j. issn. 1674-7380. 2010. 04. 013.Fatty Liver and Alcoholic Liver Disease Study Group of the Chinese Liver Disease Association. Guidelines for diagnosis and treatment of nonalcoholic fatty liver diseases[J]. Chinese Journal of Liver Diseases(Electronic Version),2010,2(4):43-48. DOI:10. 3969/j. issn.1674-7380. 2010. 04. 013.
[4]曹建彪,陈永平,成军,等.瞬时弹性成像技术(TE)临床应用专家共识(2015年)[J].中国肝脏病杂志(电子版),2015,7(2):12-18. 10. 3969/j. issn. 1674-7380. 2015. 02. 002.CAO J B,CHEN Y P,CHENG J,et al. Expert consensus on clinical application of transient elastography(TE)(2015)[J]. Chinese Journal of Liver Diseases(Electronic Version),2015,7(2):12-18. DOI:10.3969/j. issn. 1674-7380. 2015. 02. 002.
[5] FARRELL G C,LARTER C Z. Nonalcoholic fatty liver disease:from steatosis to cirrhosis[J]. Hepatology,2006,43(2 Suppl 1):S99-S112. DOI:10. 1002/hep. 20973.
[6] DE ALWIS N M,DAY C P. Non-alcoholic fatty liver disease:the mist gradually clears[J]. J Hepatol,2008,48 Suppl 1:S104-S112. DOI:10. 1016/j. jhep. 2008. 01. 009.
[7] VUPPALANCHI R,CHALASANI N. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis:selected practical issues in their evaluation and management[J]. Hepatology,2009,49(1):306-317.DOI:10. 1002/hep. 22603.
[8] KIM G A,LEE H C,CHOE J,et al. Association between non-alcoholic fatty liver disease and cancer incidence rate[J]. J Hepatol,2017,pii:S0168-8278(17)32294-32298. DOI:10. 1016/j. jhep.2017. 09. 012.
[9] DIEHL A M,DAY C. Cause,pathogenesis,and treatment of nonalcoholic steatohepatitis[J]. N Engl J Med,2017,377(21):2063-2072. DOI:10. 1056/NEJMra1503519.
[10] STL P. Liver fibrosis in non-alcoholic fatty liver disease-diagnostic challenge with prognostic significance[J]. World J Gastroenterol,2015,21(39):11077-11087. DOI:10. 3748/wjg. v21. i39. 11077.
[11] ANGULO P,HUI J M,MARCHEINI G,et al. The NAFLDfibrosis score:a noninvasive system that identifies liver fibrosis in patients with NAFLD[J]. Hepatology,2007,45(4):846-854. DOI:10.1002/hep. 21496.
[12] ROSSO C,MEZZABOTTA L,GAGGINI M,et al. Periperal insulin resistance predicts liver damage in nondiabetic subjects with nonalcoholic fatty liver disease[J]. Hepatology,2016,63(1):107-116.DOI:10. 1002/hep. 28287.
[13]柳涛,张莉,范建高,等.《2016年英国国家卫生与临床优化研究所非酒精性脂肪性肝病的评估和管理指南》摘译[J].临床肝胆病杂志,2016,32(11):2036-2038. DOI:10. 3969/j. issn.1001-5256. 2016. 11. 003.LIU T,ZHANG L,FAN J G,et al. An excerpt of non-alcoholic fatty liver disease(NAFLD):assessment and management(NICE guidelines in 2016[J]. J Clin Hepatol,2016,32(11):2036-2018.DOI:10. 3969/j. issn. 1001-5256. 2016. 11. 003.
[14]侯飞飞,祁兴顺,郭晓钟.《2015年美国超声放射医师学会共识声明:弹性成像评估肝纤维化》摘译[J].临床肝胆病杂志,2015,31(9):1384-1388. DOI:10. 3969/j. issn. 1001-5256. 2015. 09. 005.HOU F F,QI X S,GUO X Z. Elastography assessment of liver fibrosis:society of radiologists in ultrasound consensus conference statement[J].J Clin Hepatol,2015,31(9):1384-1388. DOI:10. 3969/j. issn.1001-5256. 2015. 09. 005.
[15]林晓玲,邓超文,胡国信.《2017年美国胃肠病学会指南:弹性成像检查在评估肝纤维化中的作用》摘译[J].临床肝胆病杂志,2017,33(10):1895-1897. DOI:10. 3969/j. issn. 1001-5256.2017. 10. 009.LIN X L,DENG C W,HU G X. An excerpt of American gastroenterological association institute guideline on the role of elastography in the evaluation of liver fibrosis(2017)[J]. J Clin Hepatol,2017,33(10):1895-1897. DOI:10. 3969/j. issn. 1001-5256. 2017.10. 009.
[16]庄小芳,马燕,王晓忠,等. 3种无创诊断技术对慢性乙型肝炎肝纤维化的评估价值比较[J].临床肝胆病杂志,2016,32(8):1508-1512. DOI:10. 3969/j. issn. 1001-5256. 2016. 08. 015.ZHUANG X F,MA Y,WANG X Z,et al. The predictive values of three noninvasive indices in diagnosis of liver fibrosis in patients with chronic hepatitis B:a comparative study[J]. J Clin Hepatol,2016,32(8):1508-1512. DOI:10. 3969/j. issn. 1001-5256. 2016.08. 015.
[17] MOTAMED N,SOHRABI M,AJDARKOSH H,et al. Fatty liver index vs waist circumference for predicting non-alcoholic fatty liver disease[J]. World J Gastroenterol,2016,22(10):3023-3030.DOI:10. 3748/wjg. v22. i10. 3023.
[18] BIRJANDI M,AYATOLLAHI S M,POURAHMAD S,et al. Prediction and diagnosis of non-alcoholic fatty liver disease(NAFLD)and identification of its associated factors using the classification tree method[J]. Iran Red Crescent Med J,2016,18(11):e32858.DOI:10. 5812/ircmj. 32858.
[19]丁玉平,张文,夏时海,等.非酒精性脂肪性肝病生化特点及其与相关疾病的关系[J].胃肠病学和肝病学杂志,2018,27(8):936-941. DOI:10. 3969/j. issn. 1006-5709. 2018. 08. 023.DING Y P,ZHANG W,XIA S H,et al. Biochemical characteristics of nonalcoholic fatty liver disease and its association with other related diseases[J]. Chin J Gastroenterol Hepatol,2018,27(8):936-941.DOI:10. 3969/j. issn. 1006-5709. 2018. 08. 023.
[20] FRACANZANI A L,PETTA S,LOMBARDI R,et al. Liver and cardiovascular damage in patients with lean nonalcoholic fatty liver disease,and association with visceral obesity[J]. Clin Gastroenterol Hepatol,2017,15(10):1604-1611. DOI:10. 1016/j. cgh. 2017.04. 045.
[20]龚先琼,李珊珊,陈少彬,等. ALT、AST、UA与非酒精性脂肪肝病理的相关性研究[J].医学研究杂志,2016,45(8):90-93.DOI:10. 11969/j. issn. 1673-548X. 2016. 08. 024.GONG X Q,LI S S,CHEN S B,et al. Relationship between ALT,AST and UA levels and liver histology in patients with nonalcoholic fatty liver disease[J]. J Med Res,2016,45(8):90-93. DOI:10.11969/j. issn. 1673-548X. 2016. 08. 024.