Bidirectional Association between Nonalcoholic Fatty Liver Disease and Gallstone Disease: A Cohort Study.
Bidirectional Association between Nonalcoholic Fatty Liver Disease and Gallstone Disease: A Cohort Study.
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DOI：
10.3390/jcm7110458
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发表时间：
2018-11-21
影响因子：
3.9
通讯作者：
Ryu S
中科院分区：
文献类型：
--
作者：
Chang Y;Noh YH;Suh BS;Kim Y;Sung E;Jung HS;Kim CW;Kwon MJ;Yun KE;Noh JW;Shin H;Cho YK;Ryu S
非酒精性脂肪性肝病（NAFLD）和胆结石性疾病（GD）经常共存，但NAFLD和GD之间的顺序关系仍然存在争议。我们前瞻性地评估了NAFLD与GD的双向关系。对接受健康检查的韩国成年人进行了队列研究，每年或每两年随访一次，平均随访6年。超声诊断脂肪肝和胆结石。NAFLD被定义为在没有过量饮酒或其他可识别原因的情况下，超声检查肝脏脂肪变性。NAFLD的严重程度由非侵入性纤维化标志物确定。在283,446名基线时没有胆结石或胆囊切除术的参与者中，有6440名参与者出现了胆结石。在基线时无NAFLD的219,641名参与者中，49,301名参与者发展为NAFLD。NAFLD组与非NAFLD组发生胆结石的多变量校正风险比（95%置信区间）为1.26（1.17-1.35）。NAFLD非侵袭性纤维化标志物的增加与胆结石发生率的增加呈分级和剂量反应性正相关（p趋势< 0.01）。胆囊结石和胆囊切除术与无GD的NAFLD事件的多变量校正风险比（95%置信区间）分别为1.14（1.07-1.22）和1.17（1.03-1.33）。这项针对青年和中年个体的大规模队列研究表明NAFLD和GD之间存在双向关联。NAFLD及其严重程度与胆结石发生率增加独立相关，GD和胆囊切除术也与NAFLD发生率增加相关。我们的研究结果表明，这两种情况可能相互影响，需要进一步的研究来阐明这种关联的潜在机制。
Nonalcoholic fatty liver disease (NAFLD) and gallstone disease (GD) are often found to coexist but the sequential relationship of NAFLD and GD to each other remains controversial. We prospectively evaluated the bidirectional relationship of NAFLD with GD. A cohort study was performed on Korean adults who underwent a health checkup and were followed annually or biennially for a mean of 6.0 years. Fatty liver and gallstones were diagnosed by ultrasound. NAFLD was defined as hepatic steatosis on ultrasonography in the absence of excessive alcohol use or other identifiable causes. The NAFLD severity was determined by non-invasive fibrosis markers. Among 283,446 participants without either gallstones or cholecystectomy at baseline, 6440 participants developed gallstones. Among 219,641 participants without NAFLD at baseline, 49,301 participants developed NAFLD. The multivariable-adjusted hazard ratio (95% confidence interval) for incident gallstone comparing the NAFLD group vs. the non-NAFLD group was 1.26 (1.17–1.35). Increased non-invasive fibrosis markers of NAFLD were positively associated with an increased incidence of gallstones in a graded and dose-responsive manner (p-trend < 0.01). The multivariable-adjusted hazard ratios (95% confidence intervals) for incident NAFLD comparing gallstone and cholecystectomy to no GD were 1.14 (1.07–1.22) and 1.17 (1.03–1.33), respectively. This large-scale cohort study of young and middle-aged individuals demonstrated a bidirectional association between NAFLD and GD. NAFLD and its severity were independently associated with an increased incidence of gallstones, while GD and cholecystectomy were also associated with incident NAFLD. Our findings indicate that the conditions may affect each other, requiring further studies to elucidate the potential mechanisms underlying this association.
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