肝移植术后新发非酒精性脂肪肝患者合并代谢综合征的初步研究

Preliminary experience of metabolic syndrome in patients with de-novo non-alcoholic fatty liver disease after liver transplantation

目的分析肝移植(liver transplantation,LT)后新发非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)患者及新发NAFLD合并代谢综合征(metabolic syndrome,MS)患者的临床特征,并探讨相关危险因素。方法收集2016年1月至2020年10月于青岛大学附属医院器官移植中心接受肝移植的患者,随访至2021年10月。将肝移植受者分为有/无新发NAFLD组,并进一步将肝移植后新发NAFLD患者分为合并/未合并MS组,分析肝移植后新发NAFLD患者及合并MS患者的临床特征,通过Logistic回归分析探讨术后新发NAFLD及合并MS的危险因素。结果本研究共纳入符合标准的324例肝移植受者,中位随访时间为2.9(2.0~4.3)年,术后新发NAFLD的发病率为21.0%(68/324),其中,合并MS的发病率为44.1%(30/68)。与术后无新发NAFLD患者相比,新发NAFLD患者的术前体重指数(body mass index,BMI)、血糖、糖化血红蛋白水平偏高,血小板水平偏低,术后随访时间长,BMI、腰围、白蛋白、甘油三酯、低密度脂蛋白、血糖、糖化血红蛋白和MS的发生率偏高(P均<0.05)。术前血小板、血糖,术后白蛋白、低密度脂蛋白、BMI是肝移植后新发NAFLD的独立危险因素(P均<0.05)。术前血糖在预测术后新发NAFLD发生方面表现良好(临界值:5.5 mmol/L,P<0.001,AUC=0.678)。肝移植后合并与不合并MS的新发NAFLD患者的术前血糖,术后BMI、腰围、糖尿病前期及糖尿病发病率、脂肪肝指数(fatty liver index,FLI)和NAFLD纤维化评分(NAFLD fibrosis score,NFS)间差异有统计学意义(P均<0.05)。术后糖尿病前期、糖尿病、FLI和术前血糖是肝移植后新发NAFLD患者合并MS的独立危险因素(P均<0.05)。结论肝移植后新发NAFLD的发病率值得重视,术后新发NAFLD患者更易合并MS。术前将血糖控制在5.5 mmol/L以内有助于降低肝移植后新发NAFLD的发病率。肝移植后随访过程中需及时关注患者的营养状况及血脂水平,白蛋白水平过高可能并不是一个好现象。术后新发NAFLD患者合并糖尿病或糖尿病前期可能提示肝移植术后新发NAFLD患者合并MS的风险增加。控制术后新发NAFLD患者的FLI水平可降低合并MS的发病风险。

Objective To analyze the clinical characteristics of patients with de-novo non-alcoholic fatty liver disease(de-novo NAFLD)and patients with de-novo NAFLD combined with metabolic syndrome(MS)after liver transplantation(LT),and to determine the related risk factors.Methods Patients who underwent LT at the Organ Transplantation Center,the Affiliated Hospital of Qingdao University,from Jan.2016 to Oc.2020 and were monitored until Oct.2021 were gathered.The recipients were divided into the group with/without de-novo NAFLD,and LT recipients with de-novo NAFLD were divided into the group with/without combined MS.Clinical characteristics of the LT recipients with de-novo NAFLD combined with MS were analyzed.Logistic regression analyses were performed to identify the risk factors for LT recipients with de-novo NAFLD and those with combined MS.Results A total of 324 LT recipients with a median follow-up of 2.9 years(range:2.0-4.3 years)were included in the study.De-novo NAFLD was diagnosed in 21.0%(68/324)of the LT recipients,and MS was diagnosed in 44.1%(30/68)of these patients.Compared with LT recipients without de-novo NAFLD,those with de-novo NAFLD had higher preoperative body mass index(BMI),blood glucose,glycated hemoglobin levels and lower platelet levels,and longer postoperative follow-up,higher BMI,waist circumference,albumin,triglycerides(TG),low-density lipoprotein(LDL),blood glucose,glycated hemoglobin levels,and the incidence of MS(all P<0.05).Preoperative platelets,glucose,postoperative albumin,LDL and BMI were independent risk factors for predicting de-novo NAFLD after LT(all P<0.05).Preoperative glucose performed well in predicting the occurrence of de-novo NAFLD(threshold:5.5mmol/L,P<0.001,AUC=0.678).The differences in Pre-LT blood glucose,post-LT BMI,waist circumference,prevalence of prediabetes or diabetes,fatty liver index(FLI),and NAFLD fibrosis score(NFS)between de-novo NAFLD LT recipients with and without combined MS were significantly different(all P<0.05).Conclusions The incidence of de-novo NAFLD after LT is noteworthy,and LT recipients with de-novo NAFLD are more likely to have a combination with MS.In preoperative treatment,keeping blood glucose to 5.5 mmol/L or below trends helps to lower the risk of de-novo NAFLD following LT.LT recipients’nutritional state and lipid levels require prompt care.High albumin levels might not be a desirable thing.De-novo NAFLD LT recipients with concomitant prediabetes or diabetes may imply an increased risk of developing comorbid MS during the post-LT follow-up.Controlling FLI levels in LT recipients with de-novo NAFLD may reduce the risk of developing comorbid MS.