肝移植术后新发非酒精性脂肪肝的危险因素

肝脏 ›› 2022, Vol. 27 ›› Issue (1): 95-97.

肝移植术后新发非酒精性脂肪肝的危险因素

冯丹妮, 张达利, 贺希, 张晓峰, 牛晓峰, 李志杰, 李丽昕, 刘佳, 庄云龙, 刘振文, 王洪波

100039 北京解放军总医院第五医学中心肝病医学部

收稿日期:2021-05-15 出版日期:2022-01-31 发布日期:2022-02-11
通讯作者: 王洪波,Email:chfwhb@sina.com,刘振文,Email:13911395948@139.com

The case-control study of the association between pre-alcoholic cirrhosis and new-onset non-alcoholic fatty liver disease after liver transplantation

FENG Dan-ni, ZHANG Da-li, HE Xi, ZHANG Xiao-feng, NIU Xiao-feng, LI Zhi-jie, LI Li-xin, LIU Jia, ZHUANG Yun-long, LIU Zhen-wen, WANG Hong-bo

Department of Liver Disease, the 5th Medical Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing 100039, China

Received:2021-05-15 Online:2022-01-31 Published:2022-02-11
Contact: WANG Hong-bo,Email:chfwhb@sina.com; LIU Zhen-wen,Email:13911395948@139.com

摘要/Abstract

摘要： 目的探究肝移植术后新发非酒精性脂肪肝(non-alcoholic fatty liver disease NAFLD)的危险因素。方法收集2015年5月至2019年5月于解放军总医院第五医学中心136例行肝移植患者的临床资料。比较移植术后新发NAFLD患者与无NAFLD患者的临床资料。应用logistic回归分析移植术后新发NAFLD的危险因素。结果肝移植术后1年时新发NAFLD的发病率为11.03% (15/136)。新发NAFLD患者与无NAFLD患者比较,术前BMI (27.85 比 23.17, P=0.003)、酒精性肝硬化 (66.7% 比 23.1%, P=0.001)、术前高血压病史 (33.3% 比 5.4%, P=0.016),肝移植术后1年时的ALT水平(24.0 U/L 比 21.5 U/L, P=0.012)差异有统计学意义。Logistic回归分析结果显示,术前酒精性肝硬化 (OR=4.79, 95%CI: 1.35~16.98)、术前高BMI (OR=1.23, 95%CI: 1.05~1.46)是术后新发NAFLD的危险因素。结论肝移植术前酒精性肝硬化和高BMI是术后新发NAFLD的危险因素。

关键词: 非酒精性脂肪肝, 酒精性肝硬化, 肝移植

Abstract: Objective To explore whether alcoholic cirrhosis before liver transplantation is a risk factor for non-alcoholic fatty liver disease (NAFLD) after liver transplantation.Methods Continuously collected the clinical data of patients with liver transplantation from May 2015 to May 2019 in the Fifth Medical Center of PLA General Hospital. New-onset NAFLD patients were screened, those who met the criteria for new-onset NAFLD were enrolled into the case group, and patients without NAFLD after liver transplantation were grouped into the control group. Analyzed the differences between the two groups of new-onset NAFLD patients and non-NAFLD patients. Logistic regression was used to analyze whether pre-transplant alcoholic cirrhosis was a risk factor for new-onset NAFLD.Results Finally, 136 patients were eligible, 15 of them who diagnosed with NAFLD were grouped into case group, and 121 of them who without NAFLD were into control group. The incidence of new-onset NAFLD at 1 year after liver transplantation was 11.03%. Compared with patients without NAFLD, preoperative median BMI (27.85 vs 23.17, P=0.003), indication for alcoholic cirrhosis (66.7% vs 23.1%, P=0.001), preoperative history of hypertension (33.3% vs 5.4%, P=0.016), and currently ALT level at 1 year after liver transplantation (24.0 U/L vs 21.5 U/L, P=0.012) were statistically significant between the two groups. Logistic regression showed that liver transplantation indications for alcoholic cirrhosis (OR=4.79, 95%CI: 1.35-16.98) and pre-liver transplantation high BMI (OR=1.23, 95%CI: 1.05-1.46) were risk factors for new-onset NAFLD.Conclusion Alcoholic cirrhosis before liver transplantation is a risk factor for new onset NAFLD.

Key words: New-onset non-alcoholic fatty liver disease, Alcoholic cirrhosis, liver transplantation

冯丹妮, 张达利, 贺希, 张晓峰, 牛晓峰, 李志杰, 李丽昕, 刘佳, 庄云龙, 刘振文, 王洪波. 肝移植术后新发非酒精性脂肪肝的危险因素[J]. 肝脏, 2022, 27(1): 95-97.

FENG Dan-ni, ZHANG Da-li, HE Xi, ZHANG Xiao-feng, NIU Xiao-feng, LI Zhi-jie, LI Li-xin, LIU Jia, ZHUANG Yun-long, LIU Zhen-wen, WANG Hong-bo. The case-control study of the association between pre-alcoholic cirrhosis and new-onset non-alcoholic fatty liver disease after liver transplantation[J]. Chinese Hepatolgy, 2022, 27(1): 95-97.

参考文献

[1] Losurdo G, Castellaneta A, Rendina M, et al. Systematic review with meta-analysis: de novo non-alcoholic fatty liver disease in liver-transplanted patients. Aliment Pharmacol Ther,2018,47:704-14.
[2] Pais R, Barritt ASt, Calmus Y, et al. NAFLD and liver transplantation: current burden and expected challenges. J Hepatol,2016,65:1245-57.
[3] Narayanan P, Mara K, Izzy M, et al. Recurrent or De Novo Allograft Steatosis and Long-term Outcomes After Liver Transplantation. Transplantation,2019,103:e14-e21.
[4] Eslam M, Newsome PN, Sarin SK, et al. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement. J Hepatol,2020,73:202-209.
[5] 中华医学会肝病学分会脂肪肝和酒精性肝病学组,中国医师协会脂肪性肝病专家委员会.酒精性肝病防治指南(2018年更新版).临床肝胆病杂志,2018,34(05):939-946.
[6] Germani G, Laryea M, Rubbia-Brandt L, et al. Management of Recurrent and De Novo NAFLD/NASH After Liver Transplantation. Transplantation,2019,103:57-67.
[7] Salameh H, Raff E, Erwin A, et al. PNPLA3 gene polymorphism is associated with predisposition to and severity of alcoholic liver disease. Am J Gastroenterol,2015,110(6):846-856.
[8] Buch S, Stickel F, Trépo E, et al. A genome-wide association study confirms PNPLA3 and identifies TM6SF2 and MBOAT7 as risk loci for alcohol-related cirrhosis. Nat Genet,2015,47(12):1443-1448.
[9] Romano A, Friuli M, Del Coco L, et al. Chronic oleoylethanolamide treatment decreases hepatic triacylglycerol level in rat liver by a PPARγ/SREBP-mediated suppression of fatty acid and triacylglycerol synthesis. Nutrients,2021,13.
[10] Seitz HK, Bataller R, Cortez-Pinto H, et al. Alcoholic liver disease. Nat Rev Dis Primers,2018,4:16.
[11] Lefere S, Puengel T, Hundertmark J, et al. Differential effects of selective- and pan-PPAR agonists on experimental steatohepatitis and hepatic macrophages. J Hepatol,2020,73(4):757-770.
[12] Stattermayer AF, Halilbasic E, Wrba F, et al. Variants in ABCB4 (MDR3) across the spectrum of cholestatic liver diseases in adults. J Hepatol,2020,73:651-663.
[13] Gitto S, Villa E. Non-alcoholic fatty liver disease and metabolic syndrome after liver transplant. Int J Mol Sci,2016,17:490.
[14] Fan JG, Kim SU, Wong VW. New trends on obesity and NAFLD in Asia. J Hepatol,2017,67:862-873.
[15] Eslam M, Sanyal AJ, et al. MAFLD: a consensus-driven proposed nomenclature for metabolic associated fatty liver disease. Gastroenterology,2020,158(7):1999-2014.
[16] Dasarathy S, Dasarathy J, Khiyami A, et al. Validity of real time ultrasound in the diagnosis of hepatic steatosis: a prospective study. J Hepatol,2009,51(6):1061-1067.