■肝病与一系列肝外多系统表现有关。然而,人们对肝脏和眼部疾病之间的联系知之甚少,尤其是白内障,全球主要的失明原因。我们的目的是调查是否严重的肝脏疾病,包括非酒精性脂肪性肝病(NAFLD),酒精性肝病(ALD),病毒性肝炎,肝纤维化和肝硬化,与白内障风险增加有关。
■在2006年至2010年期间,共有326,558名基线无白内障的参与者被纳入英国生物银行。感兴趣的暴露是严重的肝脏疾病(定义为住院),包括NAFLD,ALD,病毒性肝炎和肝纤维化和肝硬化。结果是意外白内障。Cox比例风险模型用于估计风险比(HR)和95%置信区间(CI)。每种肝病首先被视为一个二进制时变变量,以调查其与白内障的关系,然后被视为三元时变变量来检查最近(0-5年内的肝病)与长期(肝脏疾病>5年)状态与白内障风险相关。
■经过13.3年的中位随访(四分位距,12.5-14.0年),37,064人被记录为发展为白内障。在患有严重NAFLD的患者中发现白内障的风险更高(HR,1.47;95%CI,1.33-1.61),ALD(HR,1.57;95%CI,1.28-1.94)和肝纤维化和肝硬化(HR,1.58;95%CI,1.35-1.85),但在病毒性肝炎患者中,当暴露被视为二元时变变量时(P=0.13)。当将暴露视为三元时变变量时,还观察到最近诊断的病毒性肝炎和白内障之间的关联(HR,1.55;95%CI,1.07-2.23)。联合模型的结果表明,它们是白内障事件的独立危险因素。在进一步的敏感性分析中没有发现实质性变化。
■严重肝病,包括NAFLD,ALD,肝纤维化和肝硬化和最近诊断的病毒性肝炎,与白内障有关。肝眼连接的启示表明眼科护理在肝脏疾病管理中的重要性,以及肝病患者在白内障早期筛查和诊断中的干预优先。
■国家自然科学基金,上海市科学技术委员会科技创新行动计划,上海申康医院发展中心临床研究计划,上海市重点临床专科计划,广东省基础与应用基础研究基金会和深圳市科技计划。
UNASSIGNED: Liver disease is linked to series of extrahepatic multisystem manifestations. However, little is known about the associations between liver and eye diseases, especially cataract, the global leading cause of blindness. We aimed to investigate whether severe liver diseases, including non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease (ALD), viral hepatitis, and liver fibrosis and cirrhosis, were associated with an increased risk of the cataract.
UNASSIGNED: A total of 326,558 participants without cataract at baseline enrolled in the UK Biobank between 2006 and 2010 were included in this prospective
study. The exposures of interest were severe liver diseases (defined as hospital admission), including NAFLD, ALD, viral hepatitis and liver fibrosis and cirrhosis. The outcome was incident cataract. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). Each liver disease was first treated as a binary time-varying variable to investigate its association with cataract, and then was treated as a ternary time-varying variable to examine the recent (liver disease within 0-5 years) vs. long-term (liver disease > 5 years) state associations with the risk of cataract.
UNASSIGNED: After a median follow-up of 13.3 years (interquartile range, 12.5-14.0 years), 37,064 individuals were documented as developing cataract. Higher risk of cataract was found in those with severe NAFLD (HR, 1.47; 95% CI, 1.33-1.61), ALD (HR, 1.57; 95% CI, 1.28-1.94) and liver fibrosis and cirrhosis (HR, 1.58; 95% CI, 1.35-1.85), but not in individuals with viral hepatitis when exposure was treated as a binary time-varying variable (P = 0.13). When treating exposure as a ternary time-varying variable, an association between recently diagnosed viral hepatitis and cataract was also observed (HR, 1.55; 95% CI, 1.07-2.23). Results from the combined model suggested they were independent risk factors for incident cataract. No substantial changes were found in further sensitivity analyses.
UNASSIGNED: Severe liver diseases, including NAFLD, ALD, liver fibrosis and cirrhosis and recently diagnosed viral hepatitis, were associated with cataract. The revelation of liver-eye connection suggests the importance of ophthalmic care in the management of liver disease, and the intervention precedence of patients with liver disease in the early screening and diagnosis of cataract.
UNASSIGNED: National Natural Science Foundation of China, Science and Technology Innovation Action Plan of Shanghai Science and Technology Commission, Clinical Research Plan of Shanghai Shenkang Hospital Development Center, Shanghai Municipal Key Clinical Specialty Program, the Guangdong Basic and Applied Basic Research Foundation and Shenzhen Science and Technology Program.