Cannabis use history is associated with increased prevalence of ascites among patients with nonalcoholic fatty liver disease: A nationwide analysis.
Cannabis use history is associated with increased prevalence of ascites among patients with nonalcoholic fatty liver disease: A nationwide analysis.
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大麻使用史与非酒精性脂肪肝患者腹水患病率增加相关：一项全国性分析
DOI：
10.4254/wjh.v12.i11.993
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发表时间：
2020-11-27
影响因子：
2.4
通讯作者：
Pyrsopoulos NT
中科院分区：
文献类型：
--
作者：
Choi CJ;Weiss SH;Nasir UM;Pyrsopoulos NT
最近的研究表明，内源性大麻素系统是治疗非酒精性脂肪性肝病（NAFLD）的潜在治疗靶点。大麻的使用与 NAFLD 风险降低相关，我们假设大麻的使用与 NAFLD 患者肝脏相关临床并发症的减少有关。评估吸食大麻对 NAFLD 住院患者肝脏相关临床结果的影响。我们基于查询 2014 年全国住院患者样本 (NIS) 中诊断为 NAFLD 的成人住院情况，进行了一项回顾性匹配队列研究。 NIS 数据库是公开的，是美国最大的全付费住院患者数据库。选择吸食大麻的患者作为病例，选择不吸食大麻的患者作为对照。根据性别、年龄、种族和合并症，以一个病例与两个对照的比例进行病例对照匹配。比较各组之间的肝脏相关结局，如门静脉高压、腹水、静脉曲张和静脉曲张出血以及肝硬化。 总共确定了 49911 例被诊断为 NAFLD 的住院患者。其中，3820例被选为大麻组，7625例非大麻病例被匹配为对照。使用大麻的患者腹水患病率较高（4.5% vs 3.6%），无论是否使用大麻，P = 0.03。门脉高压（2.1% vs 2.2%）、静脉曲张和静脉曲张出血（1.3% vs 1.7%）以及肝硬化（3.7% vs 3.6%）的患病率在两组之间没有差异，无论是否使用大麻，均 P > 0.05。高脂血症、白人、黑人、亚洲人、太平洋岛民或美洲原住民以外的种族/民族以及较高的合并症评分是大麻组腹水的独立危险因素。在非大麻使用者中，肥胖和高脂血症是腹水的独立保护因素，而年龄较大、美洲原住民和较高的合并症指数是腹水的独立危险因素。 大麻与较高的腹水发生率相关，但门静脉高压、静脉曲张和静脉曲张出血以及肝硬化的患病率没有统计学差异。
Recent studies have revealed the endocannabinoid system as a potential therapeutic target in the management of nonalcoholic fatty liver disease (NAFLD). Cannabis use is associated with reduced risk for NAFLD, we hypothesized that cannabis use would be associated with less liver-related clinical complications in patients with NAFLD. To assess the effects of cannabis use on liver-related clinical outcomes in hospitalized patients with NAFLD. We performed a retrospective matched cohort study based on querying the 2014 National Inpatient Sample (NIS) for hospitalizations of adults with a diagnosis of NAFLD. The NIS database is publicly available and the largest all-payer inpatient database in the United States. The patients with cannabis use were selected as cases and those without cannabis were selected as controls. Case-control matching at a ratio of one case to two controls was performed based on sex, age, race, and comorbidities. The liver-related outcomes such as portal hypertension, ascites, varices and variceal bleeding, and cirrhosis were compared between the groups. A total of 49911 weighed hospitalizations with a diagnosis of NAFLD were identified. Of these, 3820 cases were selected as the cannabis group, and 7625 non-cannabis cases were matched as controls. Patients with cannabis use had a higher prevalence of ascites (4.5% vs 3.6%), with and without cannabis use, P = 0.03. The prevalence of portal hypertension (2.1% vs 2.2%), varices and variceal bleeding (1.3% vs 1.7%), and cirrhosis (3.7% vs 3.6%) was not different between the groups, with and without cannabis use, all P > 0.05. Hyperlipidemia, race/ethnicity other than White, Black, Asian, Pacific Islander or Native American, and higher comorbidity score were independent risk factors for ascites in the cannabis group. Among non-cannabis users, obesity and hyperlipidemia were independent protective factors against ascites while older age, Native American and higher comorbidity index were independent risk factors for ascites. Cannabis was associated with higher rates of ascites, but there was no statistical difference in the prevalence of portal hypertension, varices and variceal bleeding, and cirrhosis.
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