代谢相关性脂肪性肝病患者发生明显肝纤维化的危险因素研究

Predictors of significant liver fibrosis in patients with metabolic associated fatty liver disease

目的分析经肝活检确诊的代谢相关性脂肪性肝病(metabolic associated fatty liver disease, MAFLD)患者发生明显肝纤维化的危险因素。方法回顾性分析193例经肝活检确诊的MAFLD患者发生明显肝纤维化的危险因素。结果与MAFLD伴无/轻微肝纤维化(F0~1)患者比较,MAFLD伴明显肝纤维化(F2~4)患者中女性比例更高、年龄更大、肥胖更多见、伴高血压病者更多(P均<0.05);与MAFLD伴无/轻微肝纤维化(F0~1)患者比较,MAFLD伴明显肝纤维化(F2~4)患者外周血中血红蛋白水平及血小板计数更低(P<0.05),血清中白蛋白及尿酸水平更低(P<0.05),而TBA及空腹血糖水平更高(P<0.05)。单因素回归分析发现,女性(OR=2.277, 95%CI:1.181~4.390)、高血压病(OR=3.305, 95%CI:1.606~6.801)、BMI(OR=1.083, 95%CI:1.006~1.167)、年龄(OR=1.030,95%CI:1.006~1.055)、血红蛋白(OR=0.978,95%CI:0.958~0.997)及血小板计数(OR=0.998,95%CI:0.989~1.000)是MAFLD患者发生明显肝纤维化的危险因素,而多因素回归分析发现,高血压病(OR=2.662,95%CI:1.092~6.489)、BMI(OR=1.163,95%CI:1.062~1.275)及血小板计数(OR=0.993,95%CI:0.987~0.999)是MAFLD患者发生明显肝纤维化的独立危险因素。结论高血压、BMI及血小板计数是肝活检确诊的MAFLD患者发生明显肝纤维化的独立危险因素。

Objective To analyze the predictors of significant liver fibrosis in liver biopsy-confirmed metabolic associated fatty liver disease(MAFLD). Methods A total of 193 liver biopsy-confirmed MAFLD patients were retrospectively enrolled and analyzed. Results Compared with MAFLD patients with F0-1 liver fibrosis, those with F2-4 liver fibrosis were more female, older, obese and a higher prevalence of hypertension(all P<0.05). The latter had a lower blood level of hemoglobin and platelet count(P<0.05), a lower serum level of albumin and uric acid(P<0.05), and a higher serum level of TBA and fasting blood glucose(P<0.05). By univariable Logistic analysis, female(OR=2.277, 95%CI: 1.181-4.390), hypertension(OR=3.305, 95%CI: 1.606-6.801), BMI(OR=1.083, 95%CI: 1.006-1.167), age(OR=1.030, 95%CI: 1.006-1.055), hemoglobin(OR=0.978, 95%CI: 0.958-0.997) and platelet count(OR=0.998, 95%CI: 0.989-1.000) were predictors of significant liver fibrosis in MAFLD. By multivariable Logistic analysis, hypertension(OR=2.662, 95%CI: 1.092-6.489), BMI(OR=1.163, 95%CI: 1.062-1.275) and platelet count(OR=0.993, 95%CI: 0.987-0.999) were independent factors of significant liver fibrosis in MAFLD. Conclusion Hypertension, BMI and platelet count were independent factors of significant liver fibrosis in liver biopsy-confirmed MAFLD.