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Renin-Angiotensin System Inhibitors, Type 2 Diabetes and Fibrosis Progression: An Observational Study in Patients with Nonalcoholic Fatty Liver Disease
BACKGROUND: The clinical determinants of fibrosis progression in nonalcoholic fatty liver disease (NAFLD) are still under definition. AIM: To assess the clinical determinants of fibrosis progression rate (FPR) in NAFLD patients with baseline and follow-up histological evaluation, with a special focu...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5029872/ https://www.ncbi.nlm.nih.gov/pubmed/27649410 http://dx.doi.org/10.1371/journal.pone.0163069 |
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author | Pelusi, Serena Petta, Salvatore Rosso, Chiara Borroni, Vittorio Fracanzani, Anna Ludovica Dongiovanni, Paola Craxi, Antonio Bugianesi, Elisabetta Fargion, Silvia Valenti, Luca |
author_facet | Pelusi, Serena Petta, Salvatore Rosso, Chiara Borroni, Vittorio Fracanzani, Anna Ludovica Dongiovanni, Paola Craxi, Antonio Bugianesi, Elisabetta Fargion, Silvia Valenti, Luca |
author_sort | Pelusi, Serena |
collection | PubMed |
description | BACKGROUND: The clinical determinants of fibrosis progression in nonalcoholic fatty liver disease (NAFLD) are still under definition. AIM: To assess the clinical determinants of fibrosis progression rate (FPR) in NAFLD patients with baseline and follow-up histological evaluation, with a special focus on the impact of pharmacological therapy. METHODS: In an observational cohort of 118 Italian patients from tertiary referral centers, liver histology was evaluated according to Kleiner. Independent predictors of FPR were selected by a stepwise regression approach. RESULTS: Median follow-up was 36 months (IQR 24–77). Twenty-five patients (18%) showed some amelioration, 63 (53%) had stability, 30 (25%) had progression of fibrosis. Patients with nonalcoholic steatohepatitis (NASH) had similar demographic and anthropometric features, but a higher prevalence of type 2 diabetes (T2D; p = 0.010), and use of renin-angiotensin axis system (RAS) inhibitors (p = 0.005). Fibrosis progression was dependent of the length of follow-up, and was associated with, but did not require, the presence of NASH (p<0.05). Both fibrosis progression and faster FPR were independently associated with higher APRI score at follow-up, absence of treatment with RAS inhibitors, and T2D diagnosis at baseline (p<0.05). There was a significant interaction between use of RAS inhibitors and T2D on FPR (p = 0.002). RAS inhibitors were associated with slower FPR in patients with (p = 0.011), but not in those without (p = NS) T2D. CONCLUSIONS: NASH is not required for fibrosis progression in NAFLD, whereas T2D seems to drive fibrogenesis independently of hepatic inflammation. Use of RAS inhibitors may contrast fibrosis progression especially in high-risk patients affected by T2D. |
format | Online Article Text |
id | pubmed-5029872 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-50298722016-10-10 Renin-Angiotensin System Inhibitors, Type 2 Diabetes and Fibrosis Progression: An Observational Study in Patients with Nonalcoholic Fatty Liver Disease Pelusi, Serena Petta, Salvatore Rosso, Chiara Borroni, Vittorio Fracanzani, Anna Ludovica Dongiovanni, Paola Craxi, Antonio Bugianesi, Elisabetta Fargion, Silvia Valenti, Luca PLoS One Research Article BACKGROUND: The clinical determinants of fibrosis progression in nonalcoholic fatty liver disease (NAFLD) are still under definition. AIM: To assess the clinical determinants of fibrosis progression rate (FPR) in NAFLD patients with baseline and follow-up histological evaluation, with a special focus on the impact of pharmacological therapy. METHODS: In an observational cohort of 118 Italian patients from tertiary referral centers, liver histology was evaluated according to Kleiner. Independent predictors of FPR were selected by a stepwise regression approach. RESULTS: Median follow-up was 36 months (IQR 24–77). Twenty-five patients (18%) showed some amelioration, 63 (53%) had stability, 30 (25%) had progression of fibrosis. Patients with nonalcoholic steatohepatitis (NASH) had similar demographic and anthropometric features, but a higher prevalence of type 2 diabetes (T2D; p = 0.010), and use of renin-angiotensin axis system (RAS) inhibitors (p = 0.005). Fibrosis progression was dependent of the length of follow-up, and was associated with, but did not require, the presence of NASH (p<0.05). Both fibrosis progression and faster FPR were independently associated with higher APRI score at follow-up, absence of treatment with RAS inhibitors, and T2D diagnosis at baseline (p<0.05). There was a significant interaction between use of RAS inhibitors and T2D on FPR (p = 0.002). RAS inhibitors were associated with slower FPR in patients with (p = 0.011), but not in those without (p = NS) T2D. CONCLUSIONS: NASH is not required for fibrosis progression in NAFLD, whereas T2D seems to drive fibrogenesis independently of hepatic inflammation. Use of RAS inhibitors may contrast fibrosis progression especially in high-risk patients affected by T2D. Public Library of Science 2016-09-20 /pmc/articles/PMC5029872/ /pubmed/27649410 http://dx.doi.org/10.1371/journal.pone.0163069 Text en © 2016 Pelusi et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Pelusi, Serena Petta, Salvatore Rosso, Chiara Borroni, Vittorio Fracanzani, Anna Ludovica Dongiovanni, Paola Craxi, Antonio Bugianesi, Elisabetta Fargion, Silvia Valenti, Luca Renin-Angiotensin System Inhibitors, Type 2 Diabetes and Fibrosis Progression: An Observational Study in Patients with Nonalcoholic Fatty Liver Disease |
title | Renin-Angiotensin System Inhibitors, Type 2 Diabetes and Fibrosis Progression: An Observational Study in Patients with Nonalcoholic Fatty Liver Disease |
title_full | Renin-Angiotensin System Inhibitors, Type 2 Diabetes and Fibrosis Progression: An Observational Study in Patients with Nonalcoholic Fatty Liver Disease |
title_fullStr | Renin-Angiotensin System Inhibitors, Type 2 Diabetes and Fibrosis Progression: An Observational Study in Patients with Nonalcoholic Fatty Liver Disease |
title_full_unstemmed | Renin-Angiotensin System Inhibitors, Type 2 Diabetes and Fibrosis Progression: An Observational Study in Patients with Nonalcoholic Fatty Liver Disease |
title_short | Renin-Angiotensin System Inhibitors, Type 2 Diabetes and Fibrosis Progression: An Observational Study in Patients with Nonalcoholic Fatty Liver Disease |
title_sort | renin-angiotensin system inhibitors, type 2 diabetes and fibrosis progression: an observational study in patients with nonalcoholic fatty liver disease |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5029872/ https://www.ncbi.nlm.nih.gov/pubmed/27649410 http://dx.doi.org/10.1371/journal.pone.0163069 |
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