摘要
目的非酒精性脂肪性肝病(nonalcoholic adipose fibrosis liver disease,NAFLD)是慢性肝病主要病因之一,NAFLD纤维化评分(NAFLD fibrosis score,NFS)是用于检测NAFLD中晚期纤维化简单可靠的方法。本研究评估NFS与NAFLD死亡相关性。方法选择2016-01-20-2016-11-20沈阳市第七人民医院治疗的NAFLD患者223例为研究对象,其中NFS≥0.676且具有严重非酒精性脂肪纤维化的112例患者纳入SF组,NFS<0.676的111例患者纳入N-SF组。患者均随访24个月。随访结束后统计两组患者死亡率,并采用多变量分析评估NFS与死亡率关系。结果随访结束后,共有109例患者死亡,SF组死亡率为69.64%,高于N-SF组的27.93%,χ2=38.824,P<0.001。多因素COX回归分析结果显示,年龄(OR=1.081,95%CI为1.012~1.033,P<0.01)、性别(OR=1.419,95%CI为1.231~1.671,P<0.01)、高血压(OR=1.354,95%CI为1.213~1.664,P<0.01)、糖尿病(OR=1.801,95%CI为1.398~2.121,P<0.01)、充血性心力衰竭(OR=1.834,95%CI为1.401~2.310,P<0.01)、中风(OR=1.901,95%CI为1.379~2.482,P<0.01)、抽烟(OR=1.794,95%CI为1.501~2.103,P<0.01)和NFS(OR=1.076,95%CI为1.098~1.134,P<0.01)均与NAFLD死亡有关联。其中NFS升高,死亡危险性增大。根据ROC曲线上约登指数最大点对应的NFS评分为0.712,以此作为预测NAFLD死亡的最佳临界值,预测非酒精性脂肪性肝病死亡灵敏度=0.792,特异性=0.919,Kappa=0.606。结论NFS是NAFLD患者死亡率的独立预测因子,对NAFLD患者NFS的检测可以帮助临床医生更好地对NAFLD患者进行风险分层。
OBJECTIVE Nonalcoholic fatty liver disease(NAFLD)is one of the main causes of chronic liver disease in the world.NAFLD fibrosis score(NFS)is a simple and reliable method to detect the middle and late stage of NAFLD fibrosis.This study is to assesse the association between NFS and NAFLD mortality.METHODS A total of 223 NAFLD patients treated in Shenyang Seventh People’s Hospital from January 20,2016 to November 20,2016 were selected as the study objects,including 112 patients with NFS≥0.676 and severe non-alcoholic fatty fibrosis were included in the SF group,and 111 patients with NFS<0.676 were included in the SF group.All patients were followed up for 24 months.At the end of follow-up,mortality of the two groups was counted,and the relationship between NFS and mortality was evaluated by multivariate analysis.RESULTS At the end of follow-up,109 patients died,and the mortality rate of SF group was 69.64%,which was higher than that of N-SF group(27.93%),χ~2=38.824,P<0.001.Multi-factor COX regression analysis results showed that age(OR=1.081,95%CI:1.012-1.033,P<0.01),gender(OR=1.419,95%CI:1.231-1.671,P<0.01),hypertension(OR=1.354,95%CI:1.213-1.664,P<0.01),diabetes(OR=1.801,95%CI:1.398-2.121,P<0.01),congestive heart failure(OR=1.834,95%CI:1.401-2.310,P<0.01),stroke(OR=1.901,95%CI:1.379-2.482,P<0.01),smoking(OR=1.794,95%CI:1.501-2.103,P<0.01),NFS(OR=1.076,95%CI:1.098-1.134,P<0.01)were all related to the death of MAFLD.The risk of death increased with the increase of NFS.According to the NFS score corresponding to the largest point of Jordan index on ROC curve was 0.712,which was the best critical value for predicting NAFLD death.The sensitivity of predicting NAFLD death was 0.792,specificity was 0.919,Kappa=0.606.CONCLUSIONS NFS was an independent predictor of mortality in patients with NAFLD.The detection of NFS in patients with NAFLD can help clinicians better stratify the risk of patients with NAFLD.
作者
甄丽影
童玉梅
ZHEN Li-ying;TONG Yu-mei(Department of Gastroenterology,Seventh People's Hospital of Shenyang,Shenyang110003,P.R.China)
出处
《社区医学杂志》
2020年第15期1085-1088,共4页
Journal Of Community Medicine
