Clinical Outcomes in Biopsy-Proven Nonalcoholic Fatty Liver Disease Patients: A Multicenter Registry-based Cohort Study
Clinical Outcomes in Biopsy-Proven Nonalcoholic Fatty Liver Disease Patients: A Multicenter Registry-based Cohort Study
复制标题
非酒精性脂肪性肝病患者活检的临床结局：一项基于登记的多中心队列研究
DOI：
10.1016/j.cgh.2022.01.002
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发表时间：
2023-01-23
影响因子：
12.6
通讯作者：
Okanoue, Takeshi
中科院分区：
文献类型：
--
作者：
Fujii, Hideki;Iwaki, Michihiro;Okanoue, Takeshi
背景与目的：目前还没有关于亚洲非酒精性脂肪性肝病（NAFLD）患者接受肝活检的临床结局的详细报告。我们的目的是调查一个大型亚洲队列活检证实的NAFLD患者的临床结局，并评估非酒精性脂肪性肝炎和纤维化分期的具体影响。（临床结果非酒精性脂肪性肝病）在亚洲，包括1398例患者。中位随访期为4.6年（范围：0.3-21.6年），共随访8874人年。在此期间，47例患者死亡，1例患者接受原位肝移植。主要死因为非肝癌（n = 10）。肝脏相关死亡的主要原因是肝衰竭（n = 9）、肝细胞癌（HCC）（n = 8）和胆管细胞癌（n = 4）。在随访期间，37例患者发生了HCC，31例发生了心血管疾病，68例发生了非肝癌（主要是乳腺癌、胃癌和结肠/直肠癌）。在我们的NAFLD患者队列中，肝脏特异性死亡率为2.34/1000人-年（95%置信区间[CI]，1.52-3.58），总死亡率为5.34/1000人-年（95% CI，4.02-7.08），HCC发病率为4.17/1000人-年（95% CI，3.02-5.75）。肝纤维化与肝脏相关事件独立相关，但与总体死亡率无关。结论：肝脏相关死亡率是亚洲活检证实NAFLD患者死亡的主要原因。虽然肝纤维化分期与肝脏相关事件独立相关，但在调整混杂因素（如脂肪性肝炎的组织学特征）后，与总死亡率无关。
BACKGROUND & AIMS: There are no detailed reports of clinical outcomes in Asian patients with nonalcoholic fatty liver disease (NAFLD) who undergo liver biopsy. We aimed to investigate the clinical outcomes of a large cohort of Asian patients with biopsy-proven NAFLD and evaluate the specific effects of nonalcoholic steatohepatitis and fibrosis stage.METHODS: This multicenter registry-based retrospective cohort study, called the CLIONE (Clinical Outcome Nonalcoholic Fatty Liver Disease) in Asia, included 1398 patients.RESULTS: The median follow-up period was 4.6 years (range, 0.3-21.6 years), representing a total of 8874 person-years of follow-up. During that time, 47 patients died, and 1 patient underwent orthotopic liver transplantation. The leading cause of death was nonhepatic cancer (n = 10). The leading causes of liver-related death were liver failure (n = 9), hepatocellular carcinoma (HCC) (n = 8), and cholangiocellular carcinoma (n = 4). During follow-up, 37 patients developed HCC, 31 developed cardiovascular disease, and 68 developed nonhepatic cancer (mainly breast, stomach, and colon/rectum). Among our cohort of patients with NAFLD, liver-specific mortality was 2.34/1000 person-years (95% confidence interval [CI], 1.52-3.58), overall mortality was 5.34/1000 person-years (95% CI, 4.02-7.08), and HCC incidence was 4.17/1000 person-years (95% CI, 3.02-5.75). Liver fibrosis was independently associated with liver related events but not overall mortality.CONCLUSIONS: Liver-related mortality was the leading cause of mortality in Asian patients with biopsy confirmed NAFLD. Although fibrosis stage was independently associated with liver-related events, it was not associated with overall mortality after adjusting for confounders, such as histologic features of steatohepatitis.