Prevalence of Nonalcoholic Steatohepatitis-Associated Cirrhosis in the United States: An Analysis of National Health and Nutrition Examination Survey Data
Prevalence of Nonalcoholic Steatohepatitis-Associated Cirrhosis in the United States: An Analysis of National Health and Nutrition Examination Survey Data
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DOI：
10.1038/ajg.2017.5
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发表时间：
2017-04-01
影响因子：
9.8
通讯作者：
Alkhouri, Naim
中科院分区：
文献类型：
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作者：
Kabbany, Mohammad Nasser;Selvakumar, Praveen Kumar Conjeevaram;Alkhouri, Naim
目的：非酒精性脂肪肝（NAFLD）包括从非酒精性脂肪肝（NAFL）到非酒精性脂肪性肝炎（NASH）、纤维化和最终肝硬化的广泛表现。NAFLD的患病率已被证明随时间推移而增加;然而，NASH肝硬化和晚期纤维化的患病率随时间的推移尚未得到充分研究。本研究的目的是评估美国成年人NASH肝硬化和NAFLD相关晚期纤维化患病率的变化。对1999-2002年和2009-2012年期间获得的国家健康和营养检查调查（NHANES）数据进行分析，以估计年龄>= 10岁的受试者中NASH肝硬化和NAFLD相关晚期纤维化的患病率。入组时已满18年。我们排除了病毒性肝炎、过量饮酒、天冬氨酸转氨酶（AST）或丙氨酸转氨酶（ALT）>500的患者和妊娠患者。肝硬化定义为AST与血小板比率指数（APRI）>2和肝功能检查异常。NASH肝硬化定义为表现出以下至少一种症状的肝硬化：肥胖、糖尿病、胰岛素抵抗（HOMA-IR >= 3）和代谢综合征。晚期纤维化通过使用APRI、纤维化-4指数（FIB-4）和NAFLD纤维化评分（NFS）的公认截止值来定义。人口加权患病率分别计算为两个组，以解释复杂的抽样方法NHANES.RESULTS：共7034 NHANES参与者从1999-2002年和2009-2012年组包括与平均年龄46.2+/-0.59和47.3+/-0.51岁，分别在筛选时。与1999- 2002年组（0.072%）相比，2009- 2012年组（0.178%，估计有417，524名美国成年人患有NASH相关肝硬化）的NASH肝硬化患病率显著较高; P值
OBJECTIVES : Nonalcoholic fatty liver disease (NAFLD) includes a wide spectrum of manifestations ranging from nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH), fibrosis and eventually cirrhosis. The prevalence of NAFLD has been shown to be increasing over time; however, the prevalence of NASH cirrhosis and advanced fibrosis over time has not been well studied. The aim of this study is to estimate the changes in prevalence of NASH cirrhosis and NAFLD-associated advanced fibrosis among adults in the United States.METHODS: National Health and Nutrition Examination Survey (NHANES) data obtained during the periods from 1999-2002 and 2009-2012 were analyzed to estimate the prevalence of NASH cirrhosis and NAFLD-associated advanced fibrosis in subjects aged >= 18 years at the time of enrollment. We excluded patients with viral hepatitis, excessive alcohol consumption, aspartate aminotransferase (AST) or alanine aminotransferase (ALT) >500 and patients who were pregnant. Cirrhosis was defined by AST to platelet ratio index (APRI) >2 and abnormal liver function tests. NASH cirrhosis was defined as cirrhosis that presented with at least one of the following: obesity, diabetes, insulin resistance (HOMA-IR >= 3), and metabolic syndrome. Advanced fibrosis was defined by using well-established cutoff values for APRI, fibrosis-4 index (FIB-4) and NAFLD fibrosis score (NFS). Population weighted prevalence was calculated separately for two groups to account for complex sampling method of NHANES.RESULTS: A total of 7034 NHANES participants from 1999-2002 and 2009-2012 group were included with mean age of 46.2+/-0.59 and 47.3+/-0.51 years, respectively, at the time of screening. The prevalence of NASH cirrhosis was significantly higher in 2009-2012 group (0.178% with an estimated 417,524 American adults with NASH-associated cirrhosis) compared to 1999-2002 group (0.072%); P value