与其他病因的肝硬化相比,NASH 相关性肝硬化患者的总生存率更高吗?一项基于人群的研究。

IF 2.8 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Journal of clinical gastroenterology Pub Date : 2024-05-29 DOI:10.1097/MCG.0000000000001992
Ritu R Singh, Harishankar Gopakumar, Sonu Dhillon
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引用次数: 0

摘要

目标和背景:非酒精性脂肪性肝炎(NASH)是肝硬化的主要病因。我们旨在探讨 NASH 肝硬化与其他病因引起的肝硬化相比的临床预后:我们利用基于电子病历的数据库(TriNetX)来研究 NASH 肝硬化的预后。我们利用适当的 ICD-10-CM 代码确定了 2016 年 1 月至 2019 年 12 月期间诊断为非酒精性脂肪肝或 NASH 和肝硬化的患者。主要结果是 3 年总生存率。次要结果是失代偿性肝硬化、肝细胞癌和肝移植。对照组为除 NASH 以外的其他病因肝硬化患者。研究组和对照组在人口统计学特征和合并症方面采用倾向得分匹配法进行匹配:我们发现了 45,063 名 NASH 肝硬化患者。NASH肝硬化队列中,年龄较大(61岁对59岁)的白人(78%对64%)、女性(58%对38%)和合并症(糖尿病、肥胖、缺血性心脏病、癌症病史、慢性肾病)较多。经过倾向评分匹配后,与非NASH肝硬化患者相比,NASH肝硬化患者的3年生存率更高(78%对74%,HR 0.79,95% CI 0.77-0.82)。在NASH肝硬化患者中,肝细胞癌的诊断率较低(6.7%对10.6%,PConclusions:与其他病因导致的肝硬化相比,NASH 肝硬化患者的 3 年总生存率可能更高。这是一个有趣的发现,因为NASH患者年龄较大,合并症较多。生存率提高的部分原因是肝移植的概率更高,以及心血管疾病的治疗效果有所改善。
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Do Patients With NASH-related Cirrhosis Have Better Overall Survival Compared With Other Etiologies of Cirrhosis? A Population-based Study.

Goals and background: Nonalcoholic steatohepatitis (NASH) is a leading cause of cirrhosis. We aim to explore the clinical outcomes of NASH cirrhosis compared with other etiologies of cirrhosis.

Methods: We utilized an EHR-based database (TriNetX) to study the outcomes of NASH cirrhosis. Patients diagnosed with NAFLD or NASH and cirrhosis between January 2016 and December 2019 were identified utilizing appropriate ICD-10-CM codes. The primary outcome was 3-year overall survival. Secondary outcomes were decompensated cirrhosis, hepatocellular carcinoma, and liver transplantation. The Control group was patients with other etiologies of cirrhosis than NASH. Study and control groups were matched for demographic characters and comorbidities using propensity score matching.

Results: We identified 45,063 patients with NASH cirrhosis. The NASH cirrhosis cohort comprised older (61 vs. 59 y) White (78% vs. 64%) women (58% vs. 38%) with more comorbidities (diabetes mellitus, obesity, ischemic heart disease, history of cancer, chronic kidney disease). After propensity score matching, patients with NASH cirrhosis had a better 3-year survival (78% vs. 74%, HR 0.79, 95% CI 0.77-0.82) compared with patients with non-NASH cirrhosis. Hepatocellular carcinoma was diagnosed less commonly in patients with NASH cirrhosis (6.7% vs. 10.6%, P<0.001), and liver transplantation was performed more often for NASH cirrhosis compared with non-NASH cirrhosis [Risk ratio 1.13 (1.08-1.18)].

Conclusions: Patients with NASH cirrhosis probably have better 3-year overall survival than other etiologies of cirrhosis. This is an interesting finding, as patients with NASH are older and have more comorbidities. Improved survival can be partly explained by a higher probability of liver transplantation and improvements in cardiovascular outcomes.

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来源期刊
Journal of clinical gastroenterology
Journal of clinical gastroenterology 医学-胃肠肝病学
CiteScore
5.60
自引率
3.40%
发文量
339
审稿时长
3-8 weeks
期刊介绍: Journal of Clinical Gastroenterology gathers the world''s latest, most relevant clinical studies and reviews, case reports, and technical expertise in a single source. Regular features include cutting-edge, peer-reviewed articles and clinical reviews that put the latest research and development into the context of your practice. Also included are biographies, focused organ reviews, practice management, and therapeutic recommendations.
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