Factores analíticos, antropométricos y dietéticos asociados al desarrollo de fibrosis en pacientes con enfermedad por hígado graso no alcohólico

espanolAntecedentes: la esteatohepatitis no alcoholica (EHNA) mantenida en el tiempo puede conducir a estadios avanzados de enfermedad hepatica y al desarrollo de hepatocarcinoma. Objetivos: evaluar los factores analiticos, antropometricos y dieteticos asociados a la presencia de fibrosis hepatica, evento que mas influye en supervivencia y evolucion. Metodos: fueron estudiados setenta y seis pacientes diagnosticados de enfermedad por higado graso no alcoholica mediante biopsia. Las biopsias fueron clasificadas segun el NAS-score (Kleiner). Se obtuvieron parametros analiticos, antropometricos y dieteticos y se calculo el indice no invasivo NAFLD Fibrosis Score (NFLD-FS). Se determinaron los niveles sericos de leptina, adiponectina, resistina y TNF-alfa. Resultados: cincuenta y seis pacientes eran hombres (73,7%), con una edad media de 44,5 ± 11,3 anos (19-68). Pacientes con fibrosis en biopsia: 39 (51,3%) (F1-F2: 84,6%; F3-4: 15,4%). Univariante: 17 mujeres (85%) presentaban fibrosis, frente a 22 hombres (39%) (p = 0,000). Los pacientes con fibrosis avanzada tenian mayor edad, menor recuento de plaquetas, menor albumina serica, mayor resistencia a la insulina (homeostatic model assessment insulin resistance, HOMA-IR), menor ingesta de lipidos, mayor nivel de leptina serica y valores mas altos de NAFLD-FS. Este indice presenta para detectar fibrosis avanzada un valor predictivo negativo del 98% y un valor predictivo positivo del 60%. Variables asociadas de forma independiente a la presencia de fibrosis (regresion logistica): sexo masculino (factor protector) (0,09, IC 95%, 0,01-0,7; p EnglishBackground: a prolonged non-alcoholic steatohepatitis (NASH) condition can lead to advanced stages of liver disease and the development of hepatocellular carcinoma. Aim: to evaluate analytical, anthropometric and dietary factors associated with the presence of fibrosis as this is the factor that most influences survival and evolution. Methods: seventy-six patients with liver biopsy-diagnosed non-alcoholic fatty liver disease (NAFLD) were included. Biopsies were scored considering the NASH criteria of Kleiner. Analytical, anthropometric and dietary (survey) parameters were obtained. NAFLD-FS is a non-invasive fibrosis index and was assessed for each patient. Leptin, adiponectin, resistin and TNF-alpha serum levels were determined. Results: fifty-six patients were male (73.7%) and the mean age was 44.5 ± 11.3 years of age (19-68). Thirty-nine (51.3%) (F1-F2: 84.6%; F3-4: 15.4%) patients had fibrosis in the liver biopsy. Seventeen females (85%) had fibrosis versus 22 males (39%), which was statistically significant by univariate analysis (p