Nonalcoholic fatty liver disease prevalence in an Italian cohort of patients with hidradenitis suppurativa: A multi-center retrospective analysis
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摘要
BACKGROUND Nonalcoholic fatty liver disease(NAFLD) includes two distinct conditions, with different histologic features and prognosis: non-alcoholic fatty liver(NAFL) and non-alcoholic steatohepatitis(NASH). Furthermore, NASH is the more aggressive necro-inflammatory form, which may accumulate fibrosis and result in End stage liver disease(ESLD). NAFLD is also linked to systemic inflammatory conditions such as psoriasis. NAFLD is currently the most common cause of ESLD in Western countries, becoming a serious public health concern.Hidradenitis suppurativa(HS) is a systemic inflammatory/autoinflammatory disease of the terminal follicular epithelium of the apocrine gland with a prevalence of 0.05% to 4.10%. Due to its systemic inflammatory behavior several comorbidities were recently associated, however liver ones were scarcely assessed.AIM To evaluate the prevalence and characteristics of NASH/NAFL in HS patients.METHODS This retrospective study is a sub-analysis of a larger study carried out in 4 Italian dermatological centers. In this cohort, there were 83 patients: 51 patients with HS only, 20 patients with HS/NAFL and 12 with HS/NASH.RESULTS Inflammatory comorbidities were present in 3.9% of HS only patients, 25% of HS/NAFL patients and 58.3% of HS/NASH patients(P < 0.001). Similarly, mean Autoinflammatory Disease Damage Index(ADDI) was significantly higher among patients with HS/NASH(5.3 ± 2.2, P < 0.001) compared to patients with HS/NAFL or HS only(2.8 ± 1.6 and 2.6 ± 1.4 respectively). Furthermore, ADDI correlates with IHS4 in HS, HS/NAFL and HS/NASH. Diabetic patients have higher Hurley score than not diabetic ones. Ultrasound examination was significantly different in the three groups.CONCLUSION HS patients displayed a high prevalence of NASH/NAFLD and ultrasound examination should be particularly addressed to patients that display high ADDI scores.
BACKGROUND Nonalcoholic fatty liver disease(NAFLD) includes two distinct conditions, with different histologic features and prognosis: non-alcoholic fatty liver(NAFL) and non-alcoholic steatohepatitis(NASH). Furthermore, NASH is the more aggressive necro-inflammatory form, which may accumulate fibrosis and result in End stage liver disease(ESLD). NAFLD is also linked to systemic inflammatory conditions such as psoriasis. NAFLD is currently the most common cause of ESLD in Western countries, becoming a serious public health concern.Hidradenitis suppurativa(HS) is a systemic inflammatory/autoinflammatory disease of the terminal follicular epithelium of the apocrine gland with a prevalence of 0.05% to 4.10%. Due to its systemic inflammatory behavior several comorbidities were recently associated, however liver ones were scarcely assessed.AIM To evaluate the prevalence and characteristics of NASH/NAFL in HS patients.METHODS This retrospective study is a sub-analysis of a larger study carried out in 4 Italian dermatological centers. In this cohort, there were 83 patients: 51 patients with HS only, 20 patients with HS/NAFL and 12 with HS/NASH.RESULTS Inflammatory comorbidities were present in 3.9% of HS only patients, 25% of HS/NAFL patients and 58.3% of HS/NASH patients(P < 0.001). Similarly, mean Autoinflammatory Disease Damage Index(ADDI) was significantly higher among patients with HS/NASH(5.3 ± 2.2, P < 0.001) compared to patients with HS/NAFL or HS only(2.8 ± 1.6 and 2.6 ± 1.4 respectively). Furthermore, ADDI correlates with IHS4 in HS, HS/NAFL and HS/NASH. Diabetic patients have higher Hurley score than not diabetic ones. Ultrasound examination was significantly different in the three groups.CONCLUSION HS patients displayed a high prevalence of NASH/NAFLD and ultrasound examination should be particularly addressed to patients that display high ADDI scores.
BACKGROUND Nonalcoholic fatty liver disease(NAFLD) includes two distinct conditions, with different histologic features and prognosis: non-alcoholic fatty liver(NAFL) and non-alcoholic steatohepatitis(NASH). Furthermore, NASH is the more aggressive necro-inflammatory form, which may accumulate fibrosis and result in End stage liver disease(ESLD). NAFLD is also linked to systemic inflammatory conditions such as psoriasis. NAFLD is currently the most common cause of ESLD in Western countries, becoming a serious public health concern.Hidradenitis suppurativa(HS) is a systemic inflammatory/autoinflammatory disease of the terminal follicular epithelium of the apocrine gland with a prevalence of 0.05% to 4.10%. Due to its systemic inflammatory behavior several comorbidities were recently associated, however liver ones were scarcely assessed.AIM To evaluate the prevalence and characteristics of NASH/NAFL in HS patients.METHODS This retrospective study is a sub-analysis of a larger study carried out in 4 Italian dermatological centers. In this cohort, there were 83 patients: 51 patients with HS only, 20 patients with HS/NAFL and 12 with HS/NASH.RESULTS Inflammatory comorbidities were present in 3.9% of HS only patients, 25% of HS/NAFL patients and 58.3% of HS/NASH patients(P < 0.001). Similarly, mean Autoinflammatory Disease Damage Index(ADDI) was significantly higher among patients with HS/NASH(5.3 ± 2.2, P < 0.001) compared to patients with HS/NAFL or HS only(2.8 ± 1.6 and 2.6 ± 1.4 respectively). Furthermore, ADDI correlates with IHS4 in HS, HS/NAFL and HS/NASH. Diabetic patients have higher Hurley score than not diabetic ones. Ultrasound examination was significantly different in the three groups.CONCLUSION HS patients displayed a high prevalence of NASH/NAFLD and ultrasound examination should be particularly addressed to patients that display high ADDI scores.
引文
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3 Sporea I,Popescu A,Dumitra?cu D,Brisc C,Nedelcu L,Trifan A,Gheorghe L,Fierbineanu Braticevici C.Nonalcoholic Fatty Liver Disease:Status Quo.J Gastrointestin Liver Dis 2018;27:439-448[PMID:30574627 DOI:10.15403/jgld.2014.1121.274]
4 Fimmel S,Zouboulis CC.Comorbidities of hidradenitis suppurativa(acne inversa).Dermatoendocrinol2010;2:9-16[PMID:21547142 DOI:10.4161/derm.2.1.12490]
5 Kurzen H,Kurokawa I,Jemec GB,Emtestam L,Sellheyer K,Giamarellos-Bourboulis EJ,Nagy I,Bechara FG,Sartorius K,Lapins J,Krahl D,Altmeyer P,Revuz J,Zouboulis CC.What causes hidradenitis suppurativa?Exp Dermatol 2008;17:455-456;discussion 457-472[PMID:18400064 DOI:10.1111/j.1600-0625.2008.00712_1.x]
6 Marzano AV,Damiani G,Ceccherini I,Berti E,Gattorno M,Cugno M.Autoinflammation in pyoderma gangrenosum and its syndromic form(pyoderma gangrenosum,acne and suppurative hidradenitis).Br JDermatol 2017;176:1588-1598[PMID:27943240 DOI:10.1111/bjd.15226]
7 Vossen ARJV,van der Zee HH,Prens EP.Hidradenitis Suppurativa:A Systematic Review Integrating Inflammatory Pathways Into a Cohesive Pathogenic Model.Front Immunol 2018;9:2965[PMID:30619323 DOI:10.3389/fimmu.2018.02965]
8 Shlyankevich J,Chen AJ,Kim GE,Kimball AB.Hidradenitis suppurativa is a systemic disease with substantial comorbidity burden:a chart-verified case-control analysis.J Am Acad Dermatol 2014;71:1144-1150[PMID:25440440 DOI:10.1016/j.jaad.2014.09.012]
9 W?odarek K,Ponikowska M,Matusiak?,Szepietowski JC.Biologics for hidradenitis suppurativa:an update.Immunotherapy 2019;11:45-59[PMID:30702012 DOI:10.1177/1203475418823529]
10 McMillan K.Hidradenitis suppurativa:number of diagnosed patients,demographic characteristics,and treatment patterns in the United States.Am J Epidemiol 2014;179:1477-1483[PMID:24812161 DOI:10.1093/aje/kwu078]
11 Saunte DML,Jemec GBE.Hidradenitis Suppurativa:Advances in Diagnosis and Treatment.JAMA 2017;318:2019-2032[PMID:29183082 DOI:10.1001/jama.2017.16691]
12 Gulliver W,Zouboulis CC,Prens E,Jemec GB,Tzellos T.Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa,based on the European guidelines for hidradenitis suppurativa.Rev Endocr Metab Disord 2016;17:343-351[PMID:26831295 DOI:10.1007/s11154-016-9328-5]
13 Food and Drug Administration(FDA).Rare Disease and Orphan Drug Designated Approvals.Available from URL:https://www.fda.gov/downloads/Drugs/DevelopmentApprovalProcess/HowDrugsareDevelopedandApprov ed/DrugandBiologicApprovalReports/NDAandBLAApprovalReports/UCM500987.pdf
14 Matusiak?.Profound consequences of hidradenitis suppurativa:a review.Br J Dermatol 2018[PMID:29744872 DOI:10.1007/s13555-018-0264-z]
15 Damiani G,di Meo N,Marzano AV.A unique pneumopathy in a patient with skin nodules and abscesses.Intern Emerg Med 2017;12:637-640[PMID:28389858 DOI:10.1007/s11739-017-1658-0]
16 Byrne CD,Targher G.NAFLD:a multisystem disease.J Hepatol 2015;62:S47-S64[PMID:25920090DOI:10.1016/j.jhep.2014.12.012]
17 Awosika O,Eleryan MG,Rengifo-Pardo M,Doherty L,Martin LW,Ehrlich A.A Case-control Study to Evaluate the Prevalence of Nonalcoholic Fatty Liver Disease Among Patients with Moderate-to-severe Psoriasis.J Clin Aesthet Dermatol 2018;11:33-37[PMID:29942422]
18 Prussick RB,Miele L.Nonalcoholic fatty liver disease in patients with psoriasis:a consequence of systemic inflammatory burden?Br J Dermatol 2018;179:16-29[PMID:29235656 DOI:10.1111/bjd.16239]
19 Fiore M,Leone S,Maraolo AE,Berti E,Damiani G.Liver Illness and Psoriatic Patients.Biomed Res Int2018;2018:3140983[PMID:29546055 DOI:10.1155/2018/3140983]
20 Cazzaniga S,Naldi L,Damiani G,Atzori L,Patta F,Guidarelli G,Bettoli V.Validation of a visual-aided questionnaire for the self-assessment of hidradenitits suppurativa.J Eur Acad Dermatol Venereol 2018;32:1993-1998[PMID:29729101 DOI:10.1111/jdv.15050]
21 Zouboulis CC,Del Marmol V,Mrowietz U,Prens EP,Tzellos T,Jemec GB.Hidradenitis Suppurativa/Acne Inversa:Criteria for Diagnosis,Severity Assessment,Classification and Disease Evaluation.Dermatology 2015;231:184-190[PMID:26139027 DOI:10.1159/000431175]
22 Saunders JB,Aasland OG,Babor TF,de la Fuente JR,Grant M.Development of the Alcohol Use Disorders Identification Test(AUDIT):WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II.Addiction 1993;88:791-804[PMID:8329970]
23 European Association for the Study of the Liver(EASL);European Association for the Study of Diabetes(EASD);European Association for the Study of Obesity(EASO).EASL-EASD-EASOClinical Practice Guidelines for the management of non-alcoholic fatty liver disease.J Hepatol 2016;64:1388-1402[PMID:27062661 DOI:10.1016/j.jhep.2015.11.004]
24 van der Zee HH,Jemec GB.New insights into the diagnosis of hidradenitis suppurativa:Clinical presentations and phenotypes.J Am Acad Dermatol 2015;73:S23-S26[PMID:26470610 DOI:10.1016/j.jaad.2015.07.047]
25 Hurley HJ.Hidradenitis suppurativa.Roenigk Roenigk’s Dermatologic Surgery:Principles and Practice(Roenigk RK,Roenigk HH Jr,eds),2nd edn.New York:Marcel Dekker,Inc 1996;623-645
26 European Hidradenitis Suppurativa Foundation Investigator Group;Zouboulis CC,Tzellos T,Kyrgidis A,Jemec GBE,Bechara FG,Ingram JR,Kanni T,Karagiannidis I,Martorell A,Pinter A,Prens EP,Presser D,Szepietowski JC,Wilden SM,Sabat R,Giamarellos-Bourboulis EJ,Schneider-Burrus S,von Stebut E,van der Zee HH,Matusiak?.Development and validation of the International Hidradenitis Suppurativa Severity Score System(IHS4),a novel dynamic scoring system to assess HS severity.Br JDermatol 2017;177:1401-1409[PMID:28636793 DOI:10.1111/bjd.15748]
27 Damiani G,Della Valle V,Iannone M,Dini V,Marzano AV.Autoinflammatory Disease Damage Index(ADDI):a possible newborn also in hidradenitis suppurativa daily practice.Ann Rheum Dis 2017;76:e25[PMID:28011453 DOI:10.1136/annrheumdis-2016-210901]
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2 Kneeman JM,Misdraji J,Corey KE.Secondary causes of nonalcoholic fatty liver disease.Therap Adv Gastroenterol 2012;5:199-207[PMID:22570680 DOI:10.1177/1756283X11430859]
3 Sporea I,Popescu A,Dumitra?cu D,Brisc C,Nedelcu L,Trifan A,Gheorghe L,Fierbineanu Braticevici C.Nonalcoholic Fatty Liver Disease:Status Quo.J Gastrointestin Liver Dis 2018;27:439-448[PMID:30574627 DOI:10.15403/jgld.2014.1121.274]
4 Fimmel S,Zouboulis CC.Comorbidities of hidradenitis suppurativa(acne inversa).Dermatoendocrinol2010;2:9-16[PMID:21547142 DOI:10.4161/derm.2.1.12490]
5 Kurzen H,Kurokawa I,Jemec GB,Emtestam L,Sellheyer K,Giamarellos-Bourboulis EJ,Nagy I,Bechara FG,Sartorius K,Lapins J,Krahl D,Altmeyer P,Revuz J,Zouboulis CC.What causes hidradenitis suppurativa?Exp Dermatol 2008;17:455-456;discussion 457-472[PMID:18400064 DOI:10.1111/j.1600-0625.2008.00712_1.x]
6 Marzano AV,Damiani G,Ceccherini I,Berti E,Gattorno M,Cugno M.Autoinflammation in pyoderma gangrenosum and its syndromic form(pyoderma gangrenosum,acne and suppurative hidradenitis).Br JDermatol 2017;176:1588-1598[PMID:27943240 DOI:10.1111/bjd.15226]
7 Vossen ARJV,van der Zee HH,Prens EP.Hidradenitis Suppurativa:A Systematic Review Integrating Inflammatory Pathways Into a Cohesive Pathogenic Model.Front Immunol 2018;9:2965[PMID:30619323 DOI:10.3389/fimmu.2018.02965]
8 Shlyankevich J,Chen AJ,Kim GE,Kimball AB.Hidradenitis suppurativa is a systemic disease with substantial comorbidity burden:a chart-verified case-control analysis.J Am Acad Dermatol 2014;71:1144-1150[PMID:25440440 DOI:10.1016/j.jaad.2014.09.012]
9 W?odarek K,Ponikowska M,Matusiak?,Szepietowski JC.Biologics for hidradenitis suppurativa:an update.Immunotherapy 2019;11:45-59[PMID:30702012 DOI:10.1177/1203475418823529]
10 McMillan K.Hidradenitis suppurativa:number of diagnosed patients,demographic characteristics,and treatment patterns in the United States.Am J Epidemiol 2014;179:1477-1483[PMID:24812161 DOI:10.1093/aje/kwu078]
11 Saunte DML,Jemec GBE.Hidradenitis Suppurativa:Advances in Diagnosis and Treatment.JAMA 2017;318:2019-2032[PMID:29183082 DOI:10.1001/jama.2017.16691]
12 Gulliver W,Zouboulis CC,Prens E,Jemec GB,Tzellos T.Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa,based on the European guidelines for hidradenitis suppurativa.Rev Endocr Metab Disord 2016;17:343-351[PMID:26831295 DOI:10.1007/s11154-016-9328-5]
13 Food and Drug Administration(FDA).Rare Disease and Orphan Drug Designated Approvals.Available from URL:https://www.fda.gov/downloads/Drugs/DevelopmentApprovalProcess/HowDrugsareDevelopedandApprov ed/DrugandBiologicApprovalReports/NDAandBLAApprovalReports/UCM500987.pdf
14 Matusiak?.Profound consequences of hidradenitis suppurativa:a review.Br J Dermatol 2018[PMID:29744872 DOI:10.1007/s13555-018-0264-z]
15 Damiani G,di Meo N,Marzano AV.A unique pneumopathy in a patient with skin nodules and abscesses.Intern Emerg Med 2017;12:637-640[PMID:28389858 DOI:10.1007/s11739-017-1658-0]
16 Byrne CD,Targher G.NAFLD:a multisystem disease.J Hepatol 2015;62:S47-S64[PMID:25920090DOI:10.1016/j.jhep.2014.12.012]
17 Awosika O,Eleryan MG,Rengifo-Pardo M,Doherty L,Martin LW,Ehrlich A.A Case-control Study to Evaluate the Prevalence of Nonalcoholic Fatty Liver Disease Among Patients with Moderate-to-severe Psoriasis.J Clin Aesthet Dermatol 2018;11:33-37[PMID:29942422]
18 Prussick RB,Miele L.Nonalcoholic fatty liver disease in patients with psoriasis:a consequence of systemic inflammatory burden?Br J Dermatol 2018;179:16-29[PMID:29235656 DOI:10.1111/bjd.16239]
19 Fiore M,Leone S,Maraolo AE,Berti E,Damiani G.Liver Illness and Psoriatic Patients.Biomed Res Int2018;2018:3140983[PMID:29546055 DOI:10.1155/2018/3140983]
20 Cazzaniga S,Naldi L,Damiani G,Atzori L,Patta F,Guidarelli G,Bettoli V.Validation of a visual-aided questionnaire for the self-assessment of hidradenitits suppurativa.J Eur Acad Dermatol Venereol 2018;32:1993-1998[PMID:29729101 DOI:10.1111/jdv.15050]
21 Zouboulis CC,Del Marmol V,Mrowietz U,Prens EP,Tzellos T,Jemec GB.Hidradenitis Suppurativa/Acne Inversa:Criteria for Diagnosis,Severity Assessment,Classification and Disease Evaluation.Dermatology 2015;231:184-190[PMID:26139027 DOI:10.1159/000431175]
22 Saunders JB,Aasland OG,Babor TF,de la Fuente JR,Grant M.Development of the Alcohol Use Disorders Identification Test(AUDIT):WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II.Addiction 1993;88:791-804[PMID:8329970]
23 European Association for the Study of the Liver(EASL);European Association for the Study of Diabetes(EASD);European Association for the Study of Obesity(EASO).EASL-EASD-EASOClinical Practice Guidelines for the management of non-alcoholic fatty liver disease.J Hepatol 2016;64:1388-1402[PMID:27062661 DOI:10.1016/j.jhep.2015.11.004]
24 van der Zee HH,Jemec GB.New insights into the diagnosis of hidradenitis suppurativa:Clinical presentations and phenotypes.J Am Acad Dermatol 2015;73:S23-S26[PMID:26470610 DOI:10.1016/j.jaad.2015.07.047]
25 Hurley HJ.Hidradenitis suppurativa.Roenigk Roenigk’s Dermatologic Surgery:Principles and Practice(Roenigk RK,Roenigk HH Jr,eds),2nd edn.New York:Marcel Dekker,Inc 1996;623-645
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