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  

An evaluation on the histological characteristics and clinical outcome of non-obese patients with nonalcoholic fatty liver disease

作　　者：王伟[1] 葛亮[2] 余宁[2] 熊晓芸[1] WANG Wei;GE Liang;YU Ning;XIONG Xiao-yun(Department of Laboratory,Institute of Occupational Disease Control and Prevention,Jiangsu Center for Disease Control and prevention,Nanjing 210028,China;Department of Laboratory,Jiangsu integrated traditional Chinese and Western medicine hospital,Nanjing,210028,China)

机构地区：[1]江苏省疾病预防控制中心职业病防治所检验科,南京210028 [2]江苏省中西医结合医院检验科

出　　处：《肝脏》2023年第3期360-363,共4页Chinese Hepatology

基　　金：江苏省预防医学会课题项目(Y2018056)。

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/m^(2)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/m^(2)、(83.4±7.0)cm、74(60,86)mmHg,肥胖型分别为28.8(26.5,31.5)kg/m^(2)、(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。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/m^(2))and obese type(BMI>25 kg/m^(2)).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/m^(2),(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/m^(2) 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

关 键 词：非酒精性脂肪性肝病 肝纤维化分期 心血管事件 

分 类 号：R575.5[医药卫生—消化系统]