Prospective Study of Outcomes in Adults with Nonalcoholic Fatty Liver Disease.
Prospective Study of Outcomes in Adults with Nonalcoholic Fatty Liver Disease.
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DOI：
10.1056/nejmoa2029349
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发表时间：
2021-10-21
期刊：
影响因子：
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通讯作者：
NASH Clinical Research Network (CRN)
中科院分区：
文献类型：
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作者：
Sanyal AJ;Van Natta ML;Clark J;Neuschwander-Tetri BA;Diehl A;Dasarathy S;Loomba R;Chalasani N;Kowdley K;Hameed B;Wilson LA;Yates KP;Belt P;Lazo M;Kleiner DE;Behling C;Tonascia J;NASH Clinical Research Network (CRN)
在非酒精性脂肪性肝病（NAFLD）的组织学谱系中，关于死亡率和肝脏和非肝脏结局的预后尚未明确定义。我们前瞻性地随访了包括NAFLD完整组织学谱在内的多中心患者群体。通过基线组织学特征比较死亡发生率和其他结局。共有1773名成人NAFLD患者被随访，平均时间为4年。全因死亡率随着纤维化分期的增加而增加（F0至F2期[无、轻度或中度纤维化]每100人年死亡0.32人，F3期[桥接纤维化]每100人年死亡0.89人，F4期[肝硬化]每100人年死亡1.76人）。每100人年肝脏相关并发症的发生率随着纤维化分期的增加而增加（F0到F2比F3比F4），如下：静脉曲张出血（0.00比0.06比0.70）、腹水（0.04比0.52比1.20）、脑病（0.02比0.75比2.39）和肝细胞癌（0.04比0.34比0.14）。与F0至F2期纤维化患者相比，F4期纤维化患者的2型糖尿病发病率也更高（7.53 vs 4.45 / 100人年），肾小球滤过率的估计降低了40%以上（2.98 vs 0.97 / 100人年）。在各个纤维化阶段，心脏事件和非肝癌的发生率相似。在调整了年龄、性别、种族、糖尿病状况和基线组织学严重程度后，任何肝失代偿事件（静脉曲张出血、腹水或脑病）的发生率与全因死亡率增加相关（调整后的风险比为6.8；95%可信区间为2.2至21.3）。在这项涉及NAFLD患者的前瞻性研究中，F3和F4期纤维化与肝脏相关并发症和死亡风险增加相关。（由美国国家糖尿病、消化和肾脏疾病研究所和其他机构资助；NAFLD DB2 ClinicalTrials.gov编号：NCT01030484。）
The prognoses with respect to mortality and hepatic and nonhepatic outcomes across the histologic spectrum of nonalcoholic fatty liver disease (NAFLD) are not well defined. We prospectively followed a multicenter patient population that included the full histologic spectrum of NAFLD. The incidences of death and other outcomes were compared across baseline histologic characteristics. A total of 1773 adults with NAFLD were followed for a median of 4 years. All-cause mortality increased with increasing fibrosis stages (0.32 deaths per 100 person-years for stage F0 to F2 [no, mild, or moderate fibrosis], 0.89 deaths per 100 persons-years for stage F3 [bridging fibrosis], and 1.76 deaths per 100 person-years for stage F4 [cirrhosis]). The incidence of liver-related complications per 100 person-years increased with fibrosis stage (F0 to F2 vs. F3 vs. F4) as follows: variceal hemorrhage (0.00 vs. 0.06 vs. 0.70), ascites (0.04 vs. 0.52 vs. 1.20), encephalopathy (0.02 vs. 0.75 vs. 2.39), and hepatocellular cancer (0.04 vs. 0.34 vs. 0.14). As compared with patients with stage F0 to F2 fibrosis, patients with stage F4 fibrosis also had a higher incidence of type 2 diabetes (7.53 vs. 4.45 events per 100 person-years) and a decrease of more than 40% in the estimated glomerular filtration rate (2.98 vs. 0.97 events per 100 person-years). The incidence of cardiac events and nonhepatic cancers were similar across fibrosis stages. After adjustment for age, sex, race, diabetes status, and baseline histologic severity, the incidence of any hepatic decompensation event (variceal hemorrhage, ascites, or encephalopathy) was associated with increased all-cause mortality (adjusted hazard ratio, 6.8; 95% confidence interval, 2.2 to 21.3). In this prospective study involving patients with NAFLD, fibrosis stages F3 and F4 were associated with increased risks of liver-related complications and death. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; NAFLD DB2 ClinicalTrials.gov number, NCT01030484.)