每日服用阿司匹林可降低NAFLD纤维化进展的风险

StephenW

Daily aspirin use reduces risk for fibrosis progression in NAFLD

Simon TG, et al. Clin Gastroenterol Hepatol. 2019;doi:10.1016/j.cgh.2019.04.061.
May 16, 2019

Results from a prospective study of patients with biopsy-proven nonalcoholic fatty liver disease showed that daily aspirin use correlated with less severe histologic features of fatty liver and nonalcoholic steatohepatitis and a lower risk for progression to advanced fibrosis.

“Recent experimental data suggest that aspirin is a promising anti-fibrotic strategy for NAFLD,” Tracey G. Simon, MD, from the Massachusetts General Hospital, and colleagues wrote. “Given the growing incidence and burden of NAFLD, understanding the potential antifibrotic benefits of aspirin remains an important unmet need.”

Between 2006 and 2015, the researchers examined 361 adults with NAFLD every 3 months to 12 months for incident advanced fibrosis. Daily aspirin use correlated with lower risk for fibrosis compared with non-regular use (adjusted OR = 0.54; 95% CI, 0.31-0.82).

Daily aspirin use also correlated with NASH histology including lower risk for prevalent ballooning (aOR = 0.45; 95% CI, 0.23-0.88), lobular inflammation (aOR = 0.85; 95% CI, 0.54-0.98), definite NASH (aOR = 0.68; 95% CI, 0.37-0.89) and advanced fibrosis (aOR = 0.46; 95% CI, 0.22-0.89) compared with non-regular use.

Longer duration of pre-enrollment daily aspirin use also correlated with lower risk for prevalent fibrosis (P = .016). Compared with less than 2 years of use, prevalent fibrosis was less common among patients with 2 years to less than 4 years of use (aOR = 0.72; 95% CI, 0.56-0.48) and those with 4 years or more of use (aOR = 0.48; 95% CI, 0.32-0.69).

Longitudinal analysis with multivariate analysis showed that the risk for advanced fibrosis was 37% lower among daily aspirin users compared with non-regular users (aHR = 0.63; 95% CI, 0.43-0.85).

Simon and colleagues noted that they did not find a significant association between nonaspirin NSAID use and risk for fibrosis progression.

“Aspirin uniquely modulates bioactive lipids by stimulating the biosynthesis of proresolving mediators, and inhibiting pro-inflammatory lipids, which in turn may prevent progressive liver damage,” they wrote. “Given the accelerating incidence and mortality of NAFLD, the potential magnitude of benefit from aspirin could be profound.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.

StephenW

每日服用阿司匹林可降低NAFLD纤维化进展的风险

西蒙TG，等。 Clin Gastroenterol Hepatol。 2019; DOI：10.1016 / j.cgh.2019.04.061。
2019年5月16日

经活检证实的非酒精性脂肪性肝病患者的前瞻性研究结果显示，每日服用阿司匹林与脂肪肝和非酒精性脂肪性肝炎的不太严重的组织学特征相关，并且进展为晚期纤维化的风险较低。

“最近的实验数据表明，阿司匹林是一种很有前景的NAFLD抗纤维化策略，”来自马萨诸塞州综合医院的医学博士Tracey G. Simon及其同事写道。 “鉴于NAFLD的发病率和负担日益增加，了解阿司匹林的潜在抗纤维化益处仍然是一项重要的未满足需求。”

在2006年至2015年期间，研究人员每3个月至12个月检查361名患有NAFLD的成人因发生晚期纤维化事件。与非常规使用相比，每日阿司匹林使用与较低的纤维化风险相关（校正OR = 0.54; 95％CI，0.31-0.82）。

每日服用阿司匹林也与NASH组织学相关，包括较低的流行性气球样本风险（aOR = 0.45; 95％CI，0.23-0.88），小叶炎症（aOR = 0.85; 95％CI，0.54-0.98），明确NASH（aOR = 0.68）与非常规使用相比，95％CI，0.37-0.89）和晚期纤维化（aOR = 0.46; 95％CI，0.22-0.89）。

每日使用阿司匹林的预注册持续时间越长，也与流行性纤维化的风险降低相关（P = .016）。与不到2年的使用相比，患有2年至不到4年的患者（aOR = 0.72; 95％CI，0.56-0.48）和使用4年或更长时间的患者（aOR）不太常见纤维化。 = 0.48; 95％CI，0.32-0.69）。

多变量分析的纵向分析显示，与非常规使用者相比，阿司匹林使用者中晚期纤维化的风险降低了37％（aHR = 0.63; 95％CI，0.43-0.85）。

Simon及其同事指出，他们未发现非阿司匹林NSAID使用与纤维化进展风险之间存在显着相关性。

他们写道：“阿司匹林通过刺激前体介质的生物合成，抑制促炎脂质来独特地调节生物活性脂质，从而可以预防进行性肝损伤。” “鉴于NAFLD的发病率和死亡率不断加快，阿司匹林的潜在益处可能是巨大的。” - 作者：Talitha Bennett

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