Relationship between Kidney Function and Liver Histology in Subjects with Nonalcoholic Steatohepatitis
Relationship between Kidney Function and Liver Histology in Subjects with Nonalcoholic Steatohepatitis
复制标题
DOI：
10.2215/cjn.05050610
复制
发表时间：
2010-12-01
影响因子：
9.8
通讯作者：
Chonchol, Michel
中科院分区：
文献类型：
--
作者：
Targher, Giovanni;Bertolini, Lorenzo;Chonchol, Michel
背景和目的：我们评估了肝活检诊断的非酒精性脂肪性肝炎（NASH）是否与肾功能下降相关，以及这种关联是否独立于胰岛素抵抗和代谢综合征的特征。设计、设置、参与者和测量：我们招募了80名连续超重的活检证实的NASH患者和80名年龄、性别和体重指数相匹配的非脂肪变性对照组。慢性肾脏疾病（CKD）被定义为估计GFR (eGFR) = 30 mg/g。结果：NASH患者eGFR显著（P < 0.001）低于对照组（75.3 +/- 12 vs 87.5 +/- 6 ml/min / 1.73 m(2)），异常蛋白尿发生率（14 vs 2.5%）和CKD发生率（25 vs 3.7%）高于对照组。在调整了年龄、性别、体重指数、吸烟状况、胰岛素抵抗（通过稳态模型评估）和代谢综合征成分后，两组之间观察到的eGFR、蛋白尿和CKD的显著差异仅略有减弱。值得注意的是，NASH的组织学严重程度（即纤维化阶段）与eGFR降低或蛋白尿增加密切相关（P < 0.01或更低），独立于潜在的混杂因素。结论：我们的研究结果表明，与对照组相比，活检证实的NASH患者eGFR中度降低，异常蛋白尿和CKD的频率更高，NASH组织学的严重程度与肾功能下降有关，独立于传统的危险因素、胰岛素抵抗和代谢综合征的组成部分。中国临床医学杂志，2010,31(5):566 - 571。doi: 10.2215 / CJN.05050610
Background and objectives: We assessed whether nonalcoholic steatohepatitis (NASH) diagnosed by liver biopsy is associated with decreased kidney function and whether such association is independent of insulin resistance and features of the metabolic syndrome.Design, settings, participants, & measurements: We enrolled 80 consecutive overweight patients with biopsy-proven NASH and 80 nonsteatotic control subjects who were matched for age, gender, and body mass index. Chronic kidney disease (CKD) was defined as the presence of estimated GFR (eGFR) of = 30 mg/g).Results: NASH patients had significantly (P < 0.001) lower eGFR (75.3 +/- 12 versus 87.5 +/- 6 ml/min per 1.73 m(2)) and a greater frequency of abnormal albuminuria (14 versus 2.5%) and CKD (25 versus 3.7%) than control subjects. The significant differences in eGFR, albuminuria, and CKD that were observed between the two groups were only slightly weakened after adjustment for age, gender, body mass index, smoking status, insulin resistance (by homeostasis model assessment), and components of the metabolic syndrome. Notably, histologic severity of NASH (i.e., fibrosis stage) was strongly associated with either decreasing eGFR or increasing albuminuria (P < 0.01 or less), independently of potential confounding factors.Conclusions: Our findings suggest that patients with biopsy-proven NASH have moderately decreased eGFR and a higher frequency of abnormal albuminuria and CKD than matched control subjects and that the severity of NASH histology is associated with decreased kidney function, independently of traditional risk factors, insulin resistance, and components of the metabolic syndrome. Clin J Am Soc Nephrol 5: 2166-2171, 2010. doi: 10.2215/CJN.05050610