Real-world data reveal a diagnostic gap in non-alcoholic fatty liver disease.
Real-world data reveal a diagnostic gap in non-alcoholic fatty liver disease.
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DOI：
10.1186/s12916-018-1103-x
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发表时间：
2018-08-13
期刊：
影响因子：
9.3
通讯作者：
Alazawi W
中科院分区：
文献类型：
--
作者：
Alexander M;Loomis AK;Fairburn-Beech J;van der Lei J;Duarte-Salles T;Prieto-Alhambra D;Ansell D;Pasqua A;Lapi F;Rijnbeek P;Mosseveld M;Avillach P;Egger P;Kendrick S;Waterworth DM;Sattar N;Alazawi W
非酒精性脂肪性肝病(NAFLD)是全球最常见的肝病病因。根据不同大小和异质性选择的队列研究，估计有20%的总人口受到影响。然而，未经选择的真实世界卫生保健记录中记录的NAFLD诊断的流行率和发病率尚不清楚。我们协调了欧洲四个主要地区的健康记录，并评估了过去十年中特定年龄和性别的非酒精性脂肪肝的患病率和发病率。数据摘自卫生改善网络(联合王国)、卫生搜索数据库(意大利)、初级保健研究信息系统(西班牙)和综合初级保健信息(荷兰)。每个数据库使用不同的编码系统。通过对数变换后的随机效应荟萃分析，将流行率和发病率估计值汇集到数据库中。有17,669,973名成年人的数据，其中176,114人被记录诊断为NAFLD。混合流行率从2007年的0.60%(95%可信区间：0.41-0.79)增加到2014年的1.85%(0.91-2.79)，增加了两倍。发病率从每1000人年1.32(0.83-1.82)增加到2.35(1.29-3.40)，翻了一番。40.6%的患者可以计算出FIB-4对肝纤维化的无创评估，其中29.6-35.7%的患者具有不确定或高危评分。在迄今为止最大的初级保健记录研究中，记录的NAFLD的比率比预期低得多，这表明诊断不足和记录不足。尽管如此，我们已经确定了该诊断的发病率和流行率正在上升。提高对NAFLD的认识可能确定谁将受益于危险因素修改或新出现的治疗方法，以防止进展为心脏代谢和肝脏并发症。本文的在线版本(10.1186/s129160181103-x)包含向授权用户提供的补充材料。
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide. It affects an estimated 20% of the general population, based on cohort studies of varying size and heterogeneous selection. However, the prevalence and incidence of recorded NAFLD diagnoses in unselected real-world health-care records is unknown. We harmonised health records from four major European territories and assessed age- and sex-specific point prevalence and incidence of NAFLD over the past decade. Data were extracted from The Health Improvement Network (UK), Health Search Database (Italy), Information System for Research in Primary Care (Spain) and Integrated Primary Care Information (Netherlands). Each database uses a different coding system. Prevalence and incidence estimates were pooled across databases by random-effects meta-analysis after a log-transformation. Data were available for 17,669,973 adults, of which 176,114 had a recorded diagnosis of NAFLD. Pooled prevalence trebled from 0.60% in 2007 (95% confidence interval: 0.41–0.79) to 1.85% (0.91–2.79) in 2014. Incidence doubled from 1.32 (0.83–1.82) to 2.35 (1.29–3.40) per 1000 person-years. The FIB-4 non-invasive estimate of liver fibrosis could be calculated in 40.6% of patients, of whom 29.6–35.7% had indeterminate or high-risk scores. In the largest primary-care record study of its kind to date, rates of recorded NAFLD are much lower than expected suggesting under-diagnosis and under-recording. Despite this, we have identified rising incidence and prevalence of the diagnosis. Improved recognition of NAFLD may identify people who will benefit from risk factor modification or emerging therapies to prevent progression to cardiometabolic and hepatic complications. The online version of this article (10.1186/s12916-018-1103-x) contains supplementary material, which is available to authorized users.
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非酒精性脂肪肝。
DOI：
10.1136/bmj.g4596
发表时间：
2014-07-29
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Sattar N;Forrest E;Preiss D
通讯作者：
Preiss D
影响因子：
13.5
作者：
Allen, Alina M.;Kim, W. Ray;Kamath, Patrick S.
通讯作者：
Kamath, Patrick S.
影响因子：
2.6
作者：
Coloma, Preciosa M.;Schuemie, Martijn J.;Sturkenboom, Miriam
通讯作者：
Sturkenboom, Miriam
DOI：
10.3399/bjgp14x682273
发表时间：
2014-11
期刊：
The British journal of general practice : the journal of the Royal College of General Practitioners
影响因子：
--
作者：
Alazawi W;Mathur R;Abeysekera K;Hull S;Boomla K;Robson J;Foster GR
通讯作者：
Foster GR
DOI：
10.1016/j.cgh.2009.05.033
发表时间：
2009-10
期刊：
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
影响因子：
--
作者：
Shah AG;Lydecker A;Murray K;Tetri BN;Contos MJ;Sanyal AJ;Nash Clinical Research Network
通讯作者：
Nash Clinical Research Network