NAFLD 3期纖維化患者的肝硬度惡化

StephenW

Liver stiffness worsens among NAFLD patients with stage 3 fibrosis
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The annual risk for cirrhosis based on liver stiffness criteria was 7% among patients with nonalcoholic fatty liver disease enriched with nonalcoholic steatohepatitis, according to research presented at The Digital International Liver Congress.

“In this study with a midterm follow-up, the liver stiffness significantly worsened only those with stage 3 fibrosis on baseline liver biopsy,” Naga P. Chalasani, MD, from Indiana University School of Medicine, gastroenterology and hepatology, said during his presentation. “These observations might be useful in clinical practice and for designing early phase clinical trials with noninvasive endpoints.”

Chalasani and colleagues performed vibration transient elastography starting in 2014 in 1,010 patients from the NASH Clinical Research Network database 2 study who had biopsy-proven NAFLD. Of these patients, 58% had definite NASH and 8% had cirrhosis on biopsy. Investigators estimated change in liver stiffness over time with random effects models, the Kaplan-Meier estimator for time to event statistics and stepwise Cox regression to assess risk factor analysis of 22 clinical, anthropometrics, histological and laboratory variables at first VCTE visit.

Results showed liver stiffness increased over time in patients with baseline stage liver fibrosis (0.57; 95% CI, 0.22-0.93 kPa/year); whereas, it did not increase in patients with other liver fibrosis stages (0.995; 95% CI, 0.992–0.998), higher portal inflammation by each point (HR = 1.5; 95% CI, 1.0–2.2), higher fibrosis by one stage (HR = 1.7; 95% CI, 1.4–2), higher international normalized ratio by 0.1 (HR = 3.3; 95% CI, 1–10.6), lobular inflammation by each point (HR = 0.8; 95% CI, 0.6–1),, and higher gamma-glutamyl transferase per U/L (HR = 1.003; 95% CI, 1–1.006) were among the risk factors associated with progression to cirrhosis.

“During follow-up in those who did not have cirrhosis at first VCTE, the annual risk was 6.8%, stiffness and the 25th percentile time to development of liver stiffness was 4.4 years,” Chalasani said. “In other words, 25% of patients in our cohort without cirrhosis at baseline VCTE developed cirrhosis by criteria in 4.4 years.”

StephenW

NAFLD 3期纖維化患者的肝硬度惡化
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根據數字國際肝臟大會上發表的研究，在患有非酒精性脂肪性肝病且富含非酒精性脂肪性肝炎的非酒精性脂肪性肝病患者中，基於肝硬度標準的肝硬化年風險為7％。

印第安納大學醫學院胃腸病學和肝病學博士Naga P. Chalasani醫師在演講中說：“在這項中期隨訪研究中，只有在基線肝活檢時只有3期纖維化的患者才有肝硬化的嚴重惡化。” 。 “這些觀察結果可能在臨床實踐中以及在設計具有非侵入性終點的早期臨床試驗時很有用。”

Chalasani及其同事從2014年開始對NASH臨床研究網絡數據庫2的1,010名經活檢證實的NAFLD患者進行了振動瞬態彈性成像。在這些患者中，有58％的患者存在明確的NASH，而有8％的患者在活檢中患有肝硬化。研究人員使用隨機效應模型，事件發生時間統計數據的Kaplan-Meier估計量和逐步Cox回歸估算了肝臟僵硬度隨時間的變化，以評估首次VCTE訪問時對22種臨床，人體測量學，組織學和實驗室變量的危險因素分析。

結果顯示，基線期肝纖維化患者的肝硬度隨時間增加（0.57； 95％CI，0.22-0.93 kPa /年）；而在其他肝纖維化階段（0.995； 95％CI，0.992–0.998），門脈炎症每點升高（HR = 1.5； 95％CI，1.0–2.2），一級肝纖維化程度更高的患者中，這種情況沒有增加（HR = 1.7; 95％CI，1.4–2），國際標準化比率高0.1（HR = 3.3; 95％CI，1–10.6），小葉發炎各點（HR = 0.8; 95％CI，0.6–2 1）和更高的每U / Lγ-谷氨酰轉移酶（HR = 1.003； 95％CI，1-1.06）是與肝硬化發展相關的危險因素。

Chalasani說：“在首次進行VCTE的那些沒有肝硬化的患者中，年風險為6.8％，僵硬，而發展為肝硬化的25％時間為4.4年。” “換句話說，在我們的隊列中，基線VCTE時無肝硬化的患者中有25％在4.4年內發展為肝硬化。”