Natural history of nonalcoholic fatty liver disease: A prospective follow-up study with serial biopsies.
Natural history of nonalcoholic fatty liver disease: A prospective follow-up study with serial biopsies.
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DOI：
10.1002/hep4.1134
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发表时间：
2018-03
影响因子：
5.1
通讯作者：
Ekstedt M
中科院分区：
文献类型：
--
作者：
Nasr P;Ignatova S;Kechagias S;Ekstedt M
非酒精性脂肪性肝病(NAFLD)是世界上最常见的慢性肝病。NAFLD的完整自然病史尚不清楚，因为很少进行高质量的后续研究。我们的目的是通过一系列活组织检查的长期随访，找到预测疾病严重程度的变量。在一项前瞻性队列研究中，129名在1988年至1993年间登记的患者被要求参加两次随访研究；生化、临床和组织学数据被记录在案。平均活检间隔时间分别为13.7(±1.7)年和9.3(±1.0)年。在研究结束时，12名患者(9.3%)发展为终末期肝病，34%发展为晚期纤维化。在113名基线低纤维化(Lt；3)患者中，16%发展为晚期纤维化。纤维化进展在基线纤维化的不同阶段之间没有差异(P = 0.374)。56名患者(43%)有孤立性脂肪变性，其中9%发展为晚期纤维化(3名经活检证实为F3-F4级的患者和2名终末期肝病患者)。纤维化期、气球膨胀和糖尿病在发展为终末期肝病的患者中更为常见；然而，没有基线的临床、组织学或生化变量来预测临床上显著的疾病进展。结论：非酒精性脂肪肝是一种高度异质性疾病，预测纤维化进展令人惊讶地困难。如果给予足够的时间，NAFLD的预后似乎比之前报道的更糟糕，16%的纤维化期和3级患者发展为晚期纤维化，9.3%的患者表现出终末期肝病的迹象。(《国际肝病通讯》2018；2：199-210)
Nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease in the world. The complete natural history of NAFLD is unknown because few high‐quality follow‐up studies have been conducted. Our aim was to find variables predicting disease severity through an extended follow‐up with serial biopsies. In a prospective cohort study, 129 patients who enrolled between 1988 and 1993 were asked to participate in a follow‐up study on two occasions; biochemical, clinical, and histologic data were documented. The mean time between biopsies was 13.7 (±1.7) and 9.3 (±1.0) years, respectively. At the end of the study period, 12 patients (9.3%) had developed end‐stage liver disease and 34% had advanced fibrosis. Out of the 113 patients with baseline low fibrosis (<3), 16% developed advanced fibrosis. Fibrosis progression did not differ among the different stages of baseline fibrosis (P = 0.374). Fifty‐six patients (43%) had isolated steatosis, of whom 9% developed advanced fibrosis (3 patients with biopsy‐proven fibrosis stage F3‐F4 and 2 patients with end‐stage liver disease). Fibrosis stage, ballooning, and diabetes were more common in patients who developed end‐stage liver disease; however, there were no baseline clinical, histologic, or biochemical variables that predicted clinical significant disease progression. Conclusion: NAFLD is a highly heterogeneous disease, and it is surprisingly hard to predict fibrosis progression. Given enough time, NAFLD seems to have a more dismal prognosis then previously reported, with 16% of patients with fibrosis stage <3 developing advanced fibrosis and 9.3% showing signs of end‐stage liver disease. (Hepatology Communications 2018;2:199–210)
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影响因子：
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