Cholelithiasis and markers of nonalcoholic fatty liver disease in patients with metabolic risk factors
Cholelithiasis and markers of nonalcoholic fatty liver disease in patients with metabolic risk factors
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DOI：
10.3109/00365521.2011.643481
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发表时间：
2012-02-01
影响因子：
1.9
通讯作者：
Payer, Juraj
中科院分区：
文献类型：
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作者：
Koller, Tomas;Kollerova, Jana;Payer, Juraj
胆石症和非酒精性脂肪肝（NAFLD）有相同的危险因素。本研究的目的是探讨这两种疾病之间的关系，并在一组具有代谢危险因素的患者中确定这两种疾病的独立预测因子。在一年的时间里，有代谢危险因素的连续性患者被纳入门诊。胆石症的定义为入选时腹部超声检查或既往行胆囊切除术时存在胆结石。NAFLD的定义是存在至少一种替代标志物，如丙氨酸氨基转移酶和/或γ-谷氨酰转肽酶升高和/或脂肪肝的超声体征。彻底排除其他常见肝病。通过多因素logistic回归分析，确定有无NAFLD患者胆石症的患病率，并将临床和实验室参数确定为NAFLD的预测因子。共纳入482例连续患者：平均年龄61岁; 61%为女性; 52%的患者有2种以上代谢风险因素（肥胖、2型糖尿病、高血压、高胆固醇血症或低HDL胆固醇）。NAFLD和胆石症分别占所有患者的41%和34%。与非NAFLD患者相比，NAFLD患者的胆石症患病率显著更高（分别为47%和26%; p < 0.0001）。在多因素Logistic回归模型中，2型糖尿病（OR = 1.99）、BMI> 25 kg/m2（OR = 1.78）和胆石症（OR = 1.77）被确定为NAFLD的独立预测因子。56%的胆石症患者患有NAFLD，而非胆石症患者为33%（p < 0.0001）。多因素Logistic回归分析显示年龄大于50岁（OR = 3.46）、NAFLD（OR = 1.92）、甘油三酯大于1.7 mmol/l（OR = 1.91）、BMI大于25 kg/m2（OR = 1.84）和总胆固醇浓度（OR = 0.711）是胆石症的独立预测因素。总之，与参考组相比，具有代谢危险因素和胆石症的患者更容易患NAFLD。胆石症是NAFLD的一个独立的危险因素，除了代谢危险因素，可以被认为是NAFLD患者肝损伤的一个额外的危险因素。此外，NAFLD是胆石症的独立危险因素，可能代表代谢综合征和胆石症之间的发病联系。
Cholelithiasis and nonalcoholic fatty liver disease (NAFLD) share the same risk factors. The aim of our study was to explore the relationship between these two conditions and to indentify independent predictors of both diseases in a cohort of patients with metabolic risk factors. Consecutive patients with metabolic risk factors referred to the outpatient clinic during a one-year period were included. Cholelithiasis was defined by the presence of gallstones on abdominal ultrasound examination at inclusion or previously performed cholecystectomy. NAFLD was defined by the presence of at least one surrogate marker such as elevated alanine aminotransferase and/or gamma-glutamyl transpeptidase and/or ultrasound signs of fatty liver. Other common liver diseases were thoroughly excluded. The prevalence of cholelithiasis among patients with and without NAFLD was determined and clinical and laboratory parameters were identified as predictors of NAFLD by multivariate logistic regression. In total, 482 consecutive patients were included: mean age 61 years; 61% were women; 52% of patients had more than 2 metabolic risk factors (obesity, type 2 diabetes, hypertension, hypertriglyceridemia, or low HDL cholesterol). NAFLD and cholelithiasis were present in 41% and 34% of all patients, respectively. Significantly higher prevalence of cholelithiasis was found among patients with NAFLD compared with patients without NAFLD (47% vs. 26%, respectively; p < 0.0001). In multivariate logistic regression model, type 2 diabetes (odds ratio (OR) = 1.99), BMI above 25 kg/m(2) (OR = 1.78), and cholelithiasis (OR = 1.77) were identified as independent predictors of NAFLD. Fifty six percent of patients with cholelithiasis had NAFLD compared with 33% of patients without cholelithiasis (p < 0.0001). Multivariate logistic regression identified age above 50 years (OR = 3.46), NAFLD (OR = 1.92), triglycerides above 1.7 mmol/l (OR = 1.91), BMI above 25 kg/m(2) (OR = 1.84), and total cholesterol concentration (OR = 0.711) as independent predictors of cholelithiasis. In conclusion, patients with metabolic risk factors and cholelithiasis suffer significantly more often from NAFLD compared with the reference group. Cholelithiasis represents an independent risk factor of NAFLD in addition to metabolic risk factors and could be regarded as an additional risk factor of liver damage in patients with NAFLD. Furthermore, NAFLD is an independent risk factor for cholelithiasis and might represent a pathogenetic link between the metabolic syndrome and cholelithiasis.