Daily Aspirin Use Associated With Reduced Risk For Fibrosis Progression In Patients With Nonalcoholic Fatty Liver Disease
Daily Aspirin Use Associated With Reduced Risk For Fibrosis Progression In Patients With Nonalcoholic Fatty Liver Disease
复制标题
DOI：
10.1016/j.cgh.2019.04.061
复制
发表时间：
2019-12-01
影响因子：
12.6
通讯作者：
Corey, Kathleen E.
中科院分区：
文献类型：
--
作者：
Simon, Tracey G.;Henson, Jacqueline;Corey, Kathleen E.
背景与目的：关于阿司匹林对非酒精性脂肪性肝病（NAFLD）患者肝纤维化影响的前瞻性研究数据很少。我们对2006年至2015年361例经活检证实的NAFLD成人进行了一项前瞻性队列研究，每3-12个月检查一次，使用经验证的指数的系列测量值定义发生的晚期纤维化（纤维化-4、NAFLD纤维化评分和天冬氨酸转氨酶与血小板比率指数）。由设盲的病理学家对基线时采集的肝活检进行组织学分析。在基线和每次检查时收集的信息包括阿司匹林和非甾体抗炎药（NSAID）使用的频率和持续时间。使用多变量调整的逻辑回归，我们估计了阿司匹林使用与流行性脂肪性肝炎（NASH）和纤维化的相关性。使用多变量校正的考克斯比例风险模型，我们估计阿司匹林的使用和纤维化进展的风险之间的关联。与非定期使用相比，每日使用阿司匹林与NASH（调整后的比值比，0.68; 95%CI，0.37-0.89）和纤维化（调整后的比值比，0.54; 95%CI，0.31-0.82）的几率显着降低相关。在基线F0-F2纤维化的个体中（n = 317），86例在3692人-年内发展为晚期纤维化。每日服用阿司匹林的患者发生晚期纤维化的风险显著低于不规律服用阿司匹林的患者（调整后的风险比[aHR]，0.63; 95%CI，0.43-0.85）。这种关系似乎是持续时间依赖性的（调整后的P趋势= 0.026），最大的好处是至少使用4年或更长时间的阿司匹林（aHR，0.50; 95% CI，0.35-0.73）。相反，使用非阿司匹林非甾体抗炎药与晚期纤维化风险无关（aHR，0.93; 95%CI，0.81-1.05）。结论：在一项活检证实的NAFLD患者的前瞻性研究中，每日使用阿司匹林与NAFLD和NASH的组织学特征不太严重相关，并且随着时间的推移进展为晚期纤维化的风险较低。
BACKGROUND & AIMS: There are few data from prospective studies on the effects of aspirin on fibrosis in patients with nonalcoholic fatty liver disease (NAFLD).METHODS: We performed a prospective cohort study of 361 adults with biopsy-confirmed NAFLD, from 2006 through 2015, examined every 3-12 months for incident advanced fibrosis defined using serial measurements of validated indices (the Fibrosis-4, NAFLD fibrosis score, and aspartate aminotransferase to platelet ratio indices). Histologic analyses of liver biopsies collected at baseline were performed by a blinded pathologist. Information collected at baseline and at each examination included frequency and duration of aspirin and nonsteroidal anti-inflammatory drug (NSAID) use. Using multivariable-adjusted logistic regression, we estimated the association of aspirin use with prevalent steatohepatitis (NASH) and fibrosis. Using multivariable-adjusted Cox proportional hazards modeling, we estimated the association between aspirin use and risk for fibrosis progression.RESULTS: At enrollment, 151 subjects used aspirin daily. Compared with non-regular use, daily aspirin use was associated with significantly lower odds of NASH (adjusted odds ratio, 0.68; 95% CI, 0.37-0.89) and fibrosis (adjusted odds ratio, 0.54; 95% CI, 0.31-0.82). Among individuals with baseline F0-F2 fibrosis (n = 317), 86 developed advanced fibrosis over 3692 person-years. Daily aspirin users had significantly lower risk for developing incident advanced fibrosis vs non-regular users (adjusted hazard ratio [aHR], 0.63; 95% CI, 0.43-0.85). This relationship appeared to be duration dependent (adjusted P trend = .026), with the greatest benefit found with at least 4 years or more of aspirin use (aHR, 0.50; 95% CI, 0.35-0.73). Conversely, use of nonaspirin NSAIDs was not associated with risk for advanced fibrosis (aHR, 0.93; 95% CI, 0.81-1.05).CONCLUSIONS: In a prospective study of patients with biopsy-proven NAFLD, daily aspirin use was associated with less severe histologic features of NAFLD and NASH, and lower risk for progression to advanced fibrosis with time.