Prospective Study
Copyright ©The Author(s) 2021.
World J Clin Cases. Jul 6, 2021; 9(19): 5112-5125
Published online Jul 6, 2021. doi: 10.12998/wjcc.v9.i19.5112
Table 1 Baseline characteristics of normal and nonalcoholic fatty liver disease groups
Normal group (n = 20)
NAFLD group (n = 50)
P value
Demographics
Age (yr)61.5 ± 10.354.7 ± 14.10.0301
Male sex, n (%)12 (60)35 (70)0.421
BMI (kg/m2)23.05 ± 0.9727.57 ± 0.6< 0.001
History, n (%)
Type 2 diabetes0 (0)6 (12)0.1052
Hypertension10 (50)20 (40)0.4450
Hyperlipidemia2 (10)16 (32)0.0571
Hyperuricemia1 (5)2 (4)0.852
Biochemical parameter
AST (U/L)21.2 ± 4.228.2 ± 10.90.0035
ALT (U/L)18.7 ± 5.637.6 ± 19.1< 0.001
GGT (U/L)23.7 ± 15.345.6 ± 40.00.0008
Albumin (g/dL)4.57 ± 0.074.57 ± 0.350.9545
Uric acid (mg/dL)5.18 ± 1.025.81 ± 1.170.048
TG (mg/dL)91.0 ± 58.6138.3 ± 66.90.0015
LDL-C (mg/dL)125.9 ± 29.4133.9 ± 35.90.3754
HDL-C (mg/dL)68.5 ± 17.755.9 ± 12.90.0017
hs-CRP (mg/dL)0.0396 ± 0.04130.1545 ± 0.24230.0028
HbA1c (%)5.82 ± 0.356.16 ± 0.780.1835
HOMA-IR1.14 ± 1.142.31 ± 1.700.0002
Serum fibrosis markers
M2BPGi0.460 ± 0.2060.507 ± 0.2260.4201
Type IV collagen 7s (ng/mL)3.09 ± 0.543.07 ± 0.690.6767
Platelet count (× 104/μL)24.00 ± 5.4725.28 ± 6.490.4197
Transient elastography measurements
LSM (kPa)3.72 ± 0.884.80 ± 2.210.0101
CAP (dB/m)225.7 ± 41.3304.2 ± 51.7< 0.001
Data are presented as mean ± standard deviation or number of patients (percentage). Comparisons between two groups were analyzed using Student's t-test, Welch’s t-test, or Mann-Whitney U test, as appropriate. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BMI: Body mass index; CAP: Controlled attenuation parameter; GGT: γ-glutamyl transpeptidase; HbA1c: Hemoglobin A1c; HDL-C: High-density lipoprotein cholesterol; HOMA-IR: Homeostasis model assessment-insulin resistance; hs-CRP: High-sensitivity C-reactive protein; LDL-C: Low-density lipoprotein cholesterol; LSM: Liver stiffness measurement; M2BPGi: Mac-2-binding protein glycan isomer; NAFLD: Nonalcoholic fatty liver disease; TG: Triglycerides.
Table 2 Comparison of data between before and after 6 mo of continuous positive airway pressure therapy in obstructive sleep apnea patients with nonalcoholic fatty liver disease
n
Before CPAP
After 6 mo of CPAP
P value
Demographics
BW (kg)5075.6 ± 13.474.8 ± 13.00.076
BMI (kg/m2)5027.6 ± 4.427.4 ± 4.40.153
Biochemical parameter
AST (U/L)5028.2 ± 10.924.7 ± 7.50.005
ALT (U/L)5037.6 ± 19.133.1 ± 22.40.021
GGT (U/L)5045.6 ± 40.042.5 ± 40.10.299
Albumin (g/dL)504.57 ± 0.354.54 ± 0.370.445
Uric acid (mg/dL))505.81 ± 1.175.79 ± 1.290.836
TG (mg/dL)47139.5 ± 67.8126.0 ± 54.80.105
LDL-C (mg/dL)50133.9 ± 35.9134.2 ± 45.70.949
HDL-C (mg/dL)5055.9 ± 12.956.1 ± 11.40.866
hs-CRP (mg/dL)490.154 ± 0.2420.152 ± 0.2050.953
HbA1c (%)506.16 ± 0.786.06 ± 0.550.120
HOMA-IR472.28 ± 1.732.46 ± 1.630.369
Serum fibrosis markers
M2BPGi500.507 ± 0.2260.539 ± 0.3140.365
Type IV collagen 7s (ng/mL)503.07 ± 0.693.09 ± 0.600.684
Platelet count (× 104/μL)4925.28 ± 6.4924.78 ± 6.430.257
Transient elastography measurements
LSM (kPa)484.61 ± 1.784.70 ± 1.940.617
CAP (dB/m)48304.0 ± 52.2303.9 ± 44.10.987
Data are presented as mean ± standard deviation. Data were examined by a paired t-test or the Wilcoxon signed-rank test, as appropriate. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BMI: Body mass index; BW: Body weight; CAP: Controlled attenuation parameter; CPAP: Continuous positive airway pressure; GGT: γ-glutamyl transpeptidase; HbA1c: Hemoglobin A1c; HDL-C: High-density lipoprotein cholesterol; HOMA-IR: Homeostasis model assessment-insulin resistance; hs-CRP: High-sensitivity C-reactive protein; LDL-C: Low-density lipoprotein cholesterol; LSM: Liver stiffness measurement; M2BPGi: Mac-2-binding protein glycan isomer; m-CI: Mean compliance index; NAFLD: Nonalcoholic fatty liver disease; OSA: Obstructive sleep apnea; TG: Triglycerides.
Table 3 Analyses of uni- and multivariate regression models for factors to improve alanine aminotransferase level in obstructive sleep apnea patients with nonalcoholic fatty liver disease
FactornPartial regression coefficientStandard errorβP value
Univariate model
Decreased factors for 6 mo
BW 502.0510.600 0.4430.001
BMI 505.5781.6640.4360.002
AST 501.3180.1340.818< 0.001
TG 470.030 0.0360.1240.407
LDL-C 50-0.0270.063-0.0610.674
HbA1c 5011.0764.0640.3660.009
HOMA-IR 470.5211.4960.0520.729
M2BPGi 504.1267.6570.0780.593
LSM481.8711.6560.1640.264
CAP480.020 0.0470.0640.667
m-CI for 6 mo of CPAP therapy50-11.8785.354-0.3050.031
Mutivariate regression model
m-CI for 6 mo of CPAP therapy50-9.890 4.928-0.2540.051
The multivariate regression model was adjusted for quantities of BW change during the 6 mo of continuous positive airway pressure therapy. AST: Aspartate aminotransferase; BMI: Body mass index; BW: Body weight; CAP: Controlled attenuation parameter; HbA1c: Hemoglobin A1c; HOMA-IR: Homeostasis model assessment-insulin resistance; LDL-C: Low-density lipoprotein cholesterol; LSM: Liver stiffness measurement; M2BPGi: Mac-2-binding protein glycan isomer; m-CI: Mean compliance index; TG: Triglycerides; β: Standardized partial regression coefficient.
Table 4 Comparison of data between before and after 6 mo of continuous positive airway pressure therapy in 17 obstructive sleep apnea patients of the nonalcoholic fatty liver disease group for whom alanine aminotransferase level was ≥ 30 U/L before continuous positive airway pressure, mean compliance index was > 0.5, and body mass index changed < ± 1 kg/m2
n
Before CPAP
After 6 mo of CPAP
P value
Demographics
Age (yr)1757.1 ± 12.2--
Male sex, number (%)1713 (76.4)--
BW (kg)1774.36 ± 13.4474.23 ± 13.270.7700
BMI (kg/m2)1727.02 ± 4.3627.03 ± 4.370.9691
Biochemical parameter
AST (U/L)1733.3 ± 9.828.5 ± 7.50.0167
ALT (U/L)1748.6 ± 18.440.9 ± 19.10.0177
GGT (U/L)1745.2 ± 24.145.6 ± 29.90.8904
Albumin (g/dL)174.51 ± 0.364.50 ± 0.350.9071
Uric acid (mg/dL)175.59 ± 0.865.45 ± 1.140.3776
TG (mg/dL)16123.4 ± 33.8139.4 ± 48.80.0819
LDL-C (mg/dL)17145.8 ± 34.0139.8 ± 34.50.3002
HDL-C (mg/dL)1758.3 ± 12.857.1 ± 13.90.5143
hs-CRP (mg/dL)160.1087 ± 0.12020.0881 ± 0.06710.3740
HbA1c (%)176.28 ± 0.926.16 ± 0.620.2636
HOMA-IR162.38 ± 1.362.87 ± 2.180.1436
Serum fibrosis markers
M2BPGi170.519 ± 0.2150.556 ± 0.1480.2151
Type IV collagen 7s (ng/mL)173.35 ± 0.703.40 ± 0.530.7018
Platelet count (× 104/μL)1725.44 ± 7.3024.65 ± 5 .700.3100
Transient elastography measurements
LSM (kPa)174.59 ± 0.974.79 ± 1.420.3243
CAP (dB/m)17306.1 ± 58.2319.8 ± 43.30.2105
Data are presented as mean ± standard deviation. Data were examined by a paired t-test or the Wilcoxon signed-rank test, as appropriate. m-CI = {sum of the following calculations for each of the 6 mo of treatment: [Continuous positive airway pressure (CPAP) usage rate of days per calendar month] × (ratio of days of CPAP use for > 4 h/d to total days of CPAP use in the same calendar month)}/6 mo. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BMI: Body mass index; BW: Body weight; CAP: Controlled attenuation parameter; CPAP: Continuous positive airway pressure; GGT: γ-glutamyl transpeptidase; HbA1c: Hemoglobin A1c; HDL-C: High-density lipoprotein cholesterol; HOMA-IR: Homeostasis model assessment-insulin resistance; hs-CRP: High-sensitivity C-reactive protein; LDL-C: Low-density lipoprotein cholesterol; LSM: Liver stiffness measurement; M2BPGi: Mac-2-binding protein glycan isomer; TG: Triglycerides.