非肥胖型非酒精性脂肪性肝病组织学特征及临床结局评价

摘要/Abstract

摘要： 目的评价非肥胖型非酒精性脂肪性肝病(NAFLD)组织学特征及临床结局。方法选取2015年1月至2021年6月期间入院诊治NAFLD患者152例,依据BMI=25kg/m2将NAFLD分为非肥胖型36例、肥胖型116例。比较非肥胖型、肥胖型NAFLD组织学特征及临床结局。结果非肥胖型NAFLD BMI、腰围、舒张压分别为23.5(22.4,24.6)kg/m²、(83.4±7.0)cm、74(60,86)mmHg,肥胖型分别为28.8(26.5,31.5)kg/m²、(99.2±11.2)cm、86(75,98)mmHg,差异有统计学意义(P<0.05);非肥胖型、肥胖型NAFLD患者AST为25(18,31)U/L、32(21,48)U/L,差异有统计学意义(P<0.05);非肥胖型NAFLD高血压、代谢综合征分别为15例(41.7%)、13例(36.1%),肥胖型68例(58.6%)、77例(66.4%),差异有统计学意义(P<0.05)。非肥胖型NAFLD脂肪变性、NAFLD活动度积分、肝细胞气球样变、肝纤维化分期、肝纤维化例数分别为35(16,52)%、(3.2±1.2)分、19例(52.8%)、(1.4±0.6)期、20例(55.6%),肥胖型分别为50(30,68)%、(3.8±1.3)分、85例(73.3%)、(1.9±0.8)期、92例(79.3%),差异有统计学意义(P<0.05);非肥胖型、肥胖型NAFLD患者LSM为6.2(4.6,8.3)kPa、8.4(6.0,12.8)kPa,差异有统计学意义(P<0.05)。随访患者,未出现死亡病例。非肥胖、肥胖型NAFLD患者心血管事件为1例(2.8%)、18例(15.5%),差异有统计学意义(P<0.05);而肝脏相关事件为1例(2.8%)、4例(3.4%),差异无统计学意义(P>0.05)。结论与肥胖型NAFLD相比,非肥胖型组织学特征较轻、临床结局较理想,不过该部分患者长期预后仍有待进一步研究。

关键词: 非酒精性脂肪性肝病, 肝纤维化分期, 心血管事件

Abstract: Objective To evaluate the histological features and clinical outcomes of non-obese patients with nonalcoholic fatty liver disease (NAFLD). Methods A total of 152 patients (81 males and 71 females) with an average age of (52.1±11.7) years old who were admitted from January 2015 to June 2021 were selected. According to their Body Mass Index (BMI), the NAFLD patients were divided into non-obese type (BMI<25 kg/m²) and obese type (BMI>25 kg/m²). The histological features and clinical outcomes of non-obese and obese NAFLD patients were compared. Results There were 36 cases of non-obese NAFLD patients and 116 cases of obese NAFLD patients. The BMI, waist circumference and diastolic blood pressure of non-obese NAFLD patients were 23.5 (22.4, 24.6) kg/m², (83.4±7.0) cm and 74 (60, 86) mmHg, respectively, which were significantly higher than those of [28.8 (26.5, 31.5) kg/m² and (99.2±11.2) cm and 86 (75, 98) mmHg, P<0.05] of the obese patients. The aspartate transaminase (AST) of non-obese and obese NAFLD patients was 25 (18, 31) U/L and 32 (21, 48) U/L, with statistical significant difference (P<0.05). There are 15 cases (41.7%) and 13 cases (36.1%) of non-obese NAFLD with hypertension and metabolic syndrome, respectively, which are significantly different from those of the obese NAFLD [68 cases (58.6%) and 77 cases (66.4%), P<0.05]. The non-obese NAFLD steatosis, NAFLD activity score, hepatocyte ballooning, liver fibrosis stage and liver fibrosis were 35 (16, 52) %, (3.2±1.2) points, 19 cases (52.8%), (1.4±0.6) stage and 20 cases (55.6%), which are significantly different from those of [50 (30, 68) %, (3.8±1.3) points, 85 cases (73.3%), (1.9±0.8) stage and 92 cases (79.3%) of the obese NAFLD patients (P<0.05]. The LSM of non-obese and obese NAFLD patients was 6.2(4.6, 8.3) kPa and 8.4(6.0, 12.8) kPa, with statistical significance (P<0.05). There were no death patients during following-up. The cardiovascular events in non-obese and obese NAFLD patients were 1 case (2.8%) and 18 cases (15.5%), respectively, with statistically significant difference (P<0.05). The liver-related events were 1 case (2.8%) and 4 cases (3.4%), respectively, without statistically significant difference (P>0.05). Conclusion Compared with obese NAFLD patients, non-obese NAFLD patients have lighter histological abnormalities and better clinical outcome, but the long-term prognosis of these patients warrants further studies.

Key words: Nonalcoholic fatty liver disease, Staging of liver fibrosis, Cardiovascular event

王伟, 葛亮, 余宁, 熊晓芸. 非肥胖型非酒精性脂肪性肝病组织学特征及临床结局评价[J]. 肝脏, 2023, 28(3): 360-363.

WANG Wei, GE Liang, YU Ning, XIONG Xiao-yun. An evaluation on the histological characteristics and clinical outcome of non-obese patients with nonalcoholic fatty liver disease[J]. Chinese Hepatolgy, 2023, 28(3): 360-363.

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