Disease progression of non-alcoholic fatty liver disease: a prospective study with paired liver biopsies at 3 years

被引:508
作者
Wong, Vincent Wai-Sun [1 ,2 ]
Wong, Grace Lai-Hung [1 ,2 ]
Choi, Paul Cheung-Lung [3 ]
Chan, Anthony Wing-Hung [3 ]
Li, Mia Ka-Po [1 ,2 ]
Chan, Hoi-Yun [1 ,2 ]
Chim, Angel Mei-Ling [1 ,2 ]
Yu, Jun [1 ,2 ]
Sung, Joseph Jao-Yiu [1 ,2 ]
Chan, Henry Lik-Yuen [1 ,2 ]
机构
[1] Chinese Univ Hong Kong, Dept Med & Therapeut, Hong Kong, Hong Kong, Peoples R China
[2] Chinese Univ Hong Kong, Inst Digest Dis, Hong Kong, Hong Kong, Peoples R China
[3] Chinese Univ Hong Kong, Dept Anat & Cellular Pathol, Hong Kong, Hong Kong, Peoples R China
关键词
NATURAL-HISTORY; CHINESE PATIENTS; NONINVASIVE MARKERS; INSULIN-RESISTANCE; SCORING SYSTEM; FOLLOW-UP; FIBROSIS; STEATOHEPATITIS; NAFLD; VALIDATION;
D O I
10.1136/gut.2009.205088
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background: Patients with non-alcoholic steatohepatitis (NASH) have increased mortality and liver-related complications. In contrast, simple steatosis is considered benign and non-progressive. Objective: To investigate disease progression in patients with different degrees of non-alcoholic fatty liver disease (NAFLD) activity. Design: Prospective longitudinal hospital-based cohort study. Patients: Fifty-two patients (age 44±9 years) with biopsyproven NAFLD had liver biopsies repeated at month 36. Results: Among 13 patients with simple steatosis at baseline, 2 (15%) had a normal liver at month 36, 3 (23%) continued to have simple steatosis, 5 (39%) developed borderline NASH and 3 (23%) developed NASH. Among 22 patients with borderline NASH at baseline, 4 (18%) had simple steatosis and 13 (59%) had borderline NASH at month 36, while 5 (23%) developed NASH. Among 17 patients with NASH at baseline, 10 (59%) continued to have NASH and 6 (35%) had borderline NASH at month 36. Only 1 (6%) patient regressed to simple steatosis. Overall, 14 (27%) patients had fibrosis progression, 25 (48%) had static disease, and 13 (25%) had fibrosis regression. Reduction in body mass index and waist circumference was independently associated with non-progressive disease activity and fibrosis. The baseline serum levels and month 36 changes in adiponectin, tumour necrosis factor α, interleukin 6 and leptin were not associated with disease progression. Serum cytokeratin-18 fragment level reflected disease activity and its change correlated with the change in NAFLD activity score (R=0.51, p<0.001). Conclusions: Patients with simple steatosis may still develop NASH and fibrosis progression. Weight reduction is associated with non-progressive disease. All patients with NAFLD should undergo periodic assessment and lifestyle modification.
引用
收藏
页码:969 / 974
页数:6
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