背景:尽管有明确的证据表明非酒精性脂肪性肝炎(NASH)进展为肝硬化,非酒精性脂肪肝(NAFL)和NASH的进展存在不确定性.
目的:我们调查了非酒精性脂肪性肝病(NAFLD)患者进展为NASH和晚期纤维化的速率,并评估了与此类进展相关的因素。
方法:对36例NAFLD患者进行了组织学评估,并进行了配对肝活检(间隔≥1年;中位数,3.8年;范围,1-10.33年)。使用NASH临床研究网络(NASHCRN)标准来评估NAFLD活性评分(NAS)。
结果:在基线时,26例(72%)患者有NAFL,10例(28%)患者有NASH。在后续行动中,27%的NAFL进展为NASH(NAS评分≥5),50%的NASH患者不再符合NASH标准.纤维化进展15例(42%),在9(25%)中回归,12例(33%)患者总体保持稳定。35%的NAFL患者有纤维化进展。NASH与NAFL患者的2型糖尿病(T2DM)发病率较高(40%vs.27%)。在基线和随访时,肝活检,非侵入性评分的复合模型,如纤维化-4(FIB-4)评分和NAFLD纤维化评分,进展者的天冬氨酸转氨酶(AST)与丙氨酸转氨酶(ALT)的比率均显着高于非进展者。
结论:NAFLD是一种动态肝病,有不同程度的进展和消退。T2DM与纤维化进展密切相关。非侵入性纤维化评分,如AST/ALT比值,FIB-4得分,和NAFLD纤维化评分可以识别那些有纤维化进展风险的人。
BACKGROUND: Although there is unequivocal evidence for progression of nonalcoholic steatohepatitis (NASH) to cirrhosis, there is uncertainty with regard to the progression to nonalcoholic fatty liver (NAFL) and NASH.
OBJECTIVE: We investigated the rate of progression to NASH and advanced fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) and assessed the factors associated with such progression.
METHODS: Histological assessment was performed in 36 patients with NAFLD with paired liver biopsies (≥1 year apart; median, 3.8 years; range, 1-10.33 years). NASH Clinical Research Network (NASH CRN) criteria were used to assess NAFLD Activity Score (NAS).
RESULTS: At baseline, 26 (72%) patients had NAFL and 10 (28%) patients had NASH. At follow-up, 27% NAFL progressed to NASH (NAS score ≥5), and 50% of patients with NASH no longer met the criteria of NASH. Fibrosis progressed in 15 (42%), regressed in 9 (25%), and remained stable in 12 (33%) patients overall. Thirty-five percent of patients with NAFL had fibrosis progression. The incidence of type 2 diabetes mellitus (T2DM) was higher in patients with NASH versus NAFL (40% vs. 27%). Both at the time of baseline and follow-up, liver biopsies, composite models of noninvasive scores such as Fibrosis-4 (FIB-4) score and NAFLD fibrosis score, and ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT) were all significantly higher in progressors than in nonprogressors.
CONCLUSIONS: NAFLD is a dynamic liver disease with varying degrees of progression and regression. T2DM was strongly associated with fibrosis progression. Noninvasive fibrosis scores such as AST/ALT ratio, FIB-4 score, and NAFLD fibrosis score can identify those at risk of fibrosis progression.