Clinical and Histologic Characterization of Nonalcoholic Steatohepatitis in African American Patients
Clinical and Histologic Characterization of Nonalcoholic Steatohepatitis in African American Patients
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DOI：
10.2337/dc17-1349
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发表时间：
2018-01-01
期刊：
影响因子：
16.2
通讯作者：
Cusi, Kenneth
中科院分区：
文献类型：
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作者：
Bril, Fernando;Portillo-Sanchez, Paola;Cusi, Kenneth
在医生中有一种普遍的误解，即非裔美国人不会患上非酒精性脂肪性肝炎（NASH）。然而，一个正式的组织学和代谢的比较，以及匹配的高加索人从来没有performed.RESEARCH设计和METHODSSixteen非洲裔美国人患者匹配2：1到高加索人（n = 134）的年龄，性别，体重指数，血红蛋白A（1C），和2型糖尿病（T2 DM）的患病率。NASH筛查包括通过质子MRS（H-1-MRS）测量肝内甘油三酯含量，如果患者患有肝脂肪变性，则进行肝活检。在口服葡萄糖耐量试验期间使用Matsuda指数评估胰岛素抵抗。与白人相比，非洲裔美国人患者肝内甘油三酯含量较低（平均SD 6.1 +/- 6.8% vs. 9.4 +/-7.5%，P = 0.007），非酒精性脂肪性肝病（NAFLD）较不常见（25.0% vs. 51.9%，P = 0.003）。然而，NASH的患病率在NAFLD患者的种族之间没有差异（57.1% vs. 73.3%，P = 0.12）。此外，它们在每个单独的组织学参数（炎症、气球样变和纤维化）中表现出相似的严重程度。在NAFLD患者中，两个种族之间的胰岛素抵抗相似（Matsuda指数：3.3 +/- 1.8 vs. 3.1 +/- 1.9，P = 0.61;脂肪组织胰岛素抵抗[Adipo-IR]指数：5.7 +/- 4.6 vs. 6.4 +/- 4.7 mmol/L mu U/mL，P = 0.53），但在非裔美国人与无NAFLD的白人患者中似乎更差（Matsuda指数：4.9 +/- 3.6 vs. 7.0 +/- 4.9，P = 0.11;脂肪-IR：3.9 +/- 2.8 vs. 2.7 +/- 2.3 mmol/L mu U/mL，P = 0.06）。非裔美国人患者也有较低的血浆甘油三酯和较高的HDL胆固醇，独立的严重程度intrahepatic triglycerid.CONCLUSIONSAlthough非裔美国人有较低的肝内甘油三酯积累，一旦NAFLD的发展，NASH发生频繁，严重，在高加索患者。因此，患有NAFLD的非裔美国人应进行NASH筛查，其临床消退程度与白人患者相同。
OBJECTIVEThere has been a widespread misconception among physicians that African Americans are protected from developing nonalcoholic steatohepatitis (NASH). However, a formal histologic and metabolic comparison against well-matched Caucasians has never been performed.RESEARCH DESIGN AND METHODSSixty-seven African American patients were matched 2:1 to Caucasians (n = 134) for age, sex, BMI, hemoglobin A(1c), and prevalence of type 2 diabetes mellitus (T2DM). Screening for NASH included measurement of intrahepatic triglyceride content by proton MRS (H-1-MRS), followed by a liver biopsy if patients had hepatic steatosis. Insulin resistance was estimated during an oral glucose tolerance test using the Matsuda Index.RESULTSCompared with Caucasians, African American patients had a lower intrahepatic triglyceride content (mean SD 6.1 +/- 6.8% vs. 9.4 +/- 7.5%, P = 0.007) and the presence of nonalcoholic fatty liver disease (NAFLD) was less common (25.0% vs. 51.9%, P = 0.003). However, prevalence of NASH was not different between ethnicities in patients with NAFLD (57.1% vs. 73.3%, P = 0.12). Moreover, they showed similar severity in each of the individual histologic parameters (inflammation, ballooning, and fibrosis). Among patients with NAFLD, insulin resistance was similar between both ethnic groups (Matsuda Index: 3.3 +/- 1.8 vs. 3.1 +/- 1.9, P = 0.61; adipose tissue insulin resistance [Adipo-IR] index: 5.7 +/- 4.6 vs. 6.4 +/- 4.7 mmol/L mu U/mL, P = 0.53) but appeared to be worse in African American versus Caucasian patients without NAFLD (Matsuda Index: 4.9 +/- 3.6 vs. 7.0 +/- 4.9, P = 0.11; Adipo-IR: 3.9 +/- 2.8 vs. 2.7 +/- 2.3 mmol/L mu U/mL, P = 0.06). African American patients also had lower plasma triglycerides and higher HDL cholesterol, independent of the severity of intrahepatic triglyceride.CONCLUSIONSAlthough African Americans have lower intrahepatic triglyceride accumulation, once NAFLD develops, NASH occurs as frequently, and as severe, as in Caucasian patients. Therefore, African Americans with NAFLD should be screened for NASH with the same degree of clinical resolve as in Caucasian patients.