Disease progression of non-alcoholic fatty liver disease: a prospective study with paired liver biopsies at 3 years
Disease progression of non-alcoholic fatty liver disease: a prospective study with paired liver biopsies at 3 years
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DOI：
10.1136/gut.2009.205088
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发表时间：
2010-07-01
期刊：
影响因子：
24.5
通讯作者：
Chan, Henry Lik-Yuen
中科院分区：
文献类型：
--
作者：
Wong, Vincent Wai-Sun;Wong, Grace Lai-Hung;Chan, Henry Lik-Yuen
背景非酒精性脂肪性肝炎（NASH）患者的死亡率和肝脏相关并发症增加。目的探讨不同程度非酒精性脂肪性肝病（NAFLD）活动性患者的疾病进展情况。设计前瞻性纵向医院队列研究。患者52例（年龄44±9 岁）经活检证实的NAFLD患者在36个月时重复进行肝活检。2例（15%）在第36个月时肝脏正常，3例（23%）继续存在单纯性脂肪变性，5例（39%）发展为临界NASH，3例（23%）发展为NASH。在22例基线时患有临界NASH的患者中，4例（18%）在第36个月时患有单纯性脂肪变性，13例（59%）患有临界NASH，而5例（23%）发展为NASH。在17名基线时患有NASH的患者中，10名（59%）在第36个月时继续患有NASH，6名（35%）患有临界NASH。仅1例（6%）患者退化为单纯性脂肪变性。总体而言，14例（27%）患者出现纤维化进展，25例（48%）患者出现静止性疾病，13例（25%）患者出现纤维化消退。体重指数和腰围的减少与非进展性疾病活动和纤维化独立相关。脂联素、肿瘤坏死因子α、白细胞介素6和瘦素的基线血清水平和36个月的变化与疾病进展无关。血清细胞角蛋白18片段水平反映了疾病活动性，其变化与NAFLD活动性评分的变化相关（R= 0.51，p <0.001）。体重减轻与非进展性疾病相关。所有NAFLD患者都应接受定期评估和生活方式调整。
BackgroundPatients with non-alcoholic steatohepatitis (NASH) have increased mortality and liver-related complications. In contrast, simple steatosis is considered benign and non-progressive.ObjectiveTo investigate disease progression in patients with different degrees of non-alcoholic fatty liver disease (NAFLD) activity.DesignProspective longitudinal hospital-based cohort study.PatientsFifty-two patients (age 44±9 years) with biopsy-proven NAFLD had liver biopsies repeated at month 36.ResultsAmong 13 patients with simple steatosis at baseline, 2 (15%) had a normal liver at month 36, 3 (23%) continued to have simple steatosis, 5 (39%) developed borderline NASH and 3 (23%) developed NASH. Among 22 patients with borderline NASH at baseline, 4 (18%) had simple steatosis and 13 (59%) had borderline NASH at month 36, while 5 (23%) developed NASH. Among 17 patients with NASH at baseline, 10 (59%) continued to have NASH and 6 (35%) had borderline NASH at month 36. Only 1 (6%) patient regressed to simple steatosis. Overall, 14 (27%) patients had fibrosis progression, 25 (48%) had static disease, and 13 (25%) had fibrosis regression. Reduction in body mass index and waist circumference was independently associated with non-progressive disease activity and fibrosis. The baseline serum levels and month 36 changes in adiponectin, tumour necrosis factor α, interleukin 6 and leptin were not associated with disease progression. Serum cytokeratin-18 fragment level reflected disease activity and its change correlated with the change in NAFLD activity score (R=0.51, p<0.001).ConclusionsPatients with simple steatosis may still develop NASH and fibrosis progression. Weight reduction is associated with non-progressive disease. All patients with NAFLD should undergo periodic assessment and lifestyle modification.