Association between noninvasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States.
Association between noninvasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States.
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DOI：
10.1002/hep.26156
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发表时间：
2013-04
期刊：
影响因子：
13.5
通讯作者：
Therneau, Terry M.
中科院分区：
文献类型：
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作者：
Kim, Donghee;Kim, W. Ray;Kim, Hwa Jung;Therneau, Terry M.
非酒精性脂肪性肝病（NAFLD）的临床和公共卫生意义尚未明确。我们研究了NAFLD对死亡率的长期影响。这项分析利用了1988-1994年进行的全国健康和营养调查以及随后截至2006年12月31日的死亡率随访数据。在没有其他已知肝脏疾病的情况下，通过超声检测肝脂肪变性来定义NAFLD。通过NAFLD纤维化评分（NFS）、AST-血小板比率指数（APRI）和FIB-4评分确定NAFLD受试者中肝纤维化的存在和严重程度。在11，154名参与者中，34.0%患有NAFLD -大多数（71.7%）患有与缺乏显著纤维化一致的NFS（NFS <-1.455），而3.2%的评分指示晚期纤维化（NFS > 0.676）。在中位随访14.5年后，NAFLD与较高的死亡率无关（年龄和性别调整的风险比（HR）1.05，95%置信区间（CI）0.93-1.19）。相反，随着纤维化评分的增加，死亡率逐渐增加。与无纤维化的受试者相比，在校正其他已知的死亡率预测因素后，晚期纤维化概率高的受试者的死亡率增加69%（NFS HR 1.69（95% CI 1.09-2.63），APRI 1.85（1.02-3.37），FIB-4 1.66（0.98-2.82））。这些死亡率的增加几乎完全来自心血管原因（NFS的HR 3.46（95% CI 1.91-6.25），APRI为2.53（1.33-4.83），FIB-4为2.68（1.44-4.99））。超声诊断的NAFLD与死亡率增加无关。然而，通过非侵入性纤维化标志物组确定的晚期纤维化是死亡率的重要预测因子，主要来自心血管原因，独立于其他已知因素。
The clinical and public health significance of non-alcoholic fatty liver disease (NAFLD) is not well established. We investigate the long-term impact of NAFLD on mortality. This analysis utilizes the National Health and Nutrition Examination Survey conducted in 1988–1994 and subsequent follow-up data for mortality through December 31, 2006. NAFLD was defined by ultrasonographic detection of hepatic steatosis in the absence of other known liver diseases. The presence and severity of hepatic fibrosis in subjects with NAFLD was determined by the NAFLD fibrosis score (NFS), the AST-platelet ratio index (APRI), and the FIB-4 score. Out of 11,154 participants, 34.0% had NAFLD - the majority (71.7%) had NFS consistent with lack of significant fibrosis (NFS < −1.455), whereas 3.2% had a score indicative of advanced fibrosis (NFS > 0.676). After a median follow-up of 14.5 years, NAFLD was not associated with higher mortality (age- and sex-adjusted hazard ratio (HR) 1.05, 95% confidence interval (CI) 0.93–1.19). In contrast, there was a progressive increase in mortality with advancing fibrosis scores. Compared to subjects without fibrosis, those with a high probability of advanced fibrosis had a 69% increase in mortality (HR 1.69 (95% CI 1.09–2.63) for NFS, 1.85 (1.02–3.37) for APRI, 1.66 (0.98–2.82) for FIB-4) after adjustment for other known predictors of mortality. These increases in mortality were almost entirely from cardiovascular causes (HR 3.46 (95% CI 1.91–6.25) for NFS, 2.53 (1.33–4.83) for APRI, 2.68 (1.44–4.99) for FIB-4). Ultrasonography-diagnosed NAFLD is not associated with increased mortality. However, advanced fibrosis as determined by non-invasive fibrosis marker panels is a significant predictor of mortality, mainly from cardiovascular causes, independent of other known factors.
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非酒精性脂肪肝病与冠状动脉钙化有关。
影响因子：
13.5
作者：
Kim, Donghee;Choi, Su-Yeon;Park, Eun Ha;Lee, Whal;Kang, Jin Hwa;Kim, Won;Kim, Yoon Jun;Yoon, Jung-Hwan;Jeong, Sook Hyang;Lee, Dong Ho;Lee, Hyo-suk;Larson, Joseph;Therneau, Terry M.;Kim, W. Ray
通讯作者：
Kim, W. Ray
DOI：
10.1136/bmj.d6891
发表时间：
2011-11-18
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Lazo M;Hernaez R;Bonekamp S;Kamel IR;Brancati FL;Guallar E;Clark JM
通讯作者：
Clark JM
影响因子：
5.1
作者：
Lim, Young-Suk;Kim, W. Ray
通讯作者：
Kim, W. Ray
影响因子：
13.5
作者：
Browning, JD;Szczepaniak, LS;Hobbs, HH
通讯作者：
Hobbs, HH
影响因子：
7.6
作者：
Angulo, P.
通讯作者：
Angulo, P.