Division of Gastroenterology, Department of Medicine, Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle, Washington 98108, USA.
Am J Gastroenterol. 2010 Jun;105(6):1364-73. doi: 10.1038/ajg.2009.737. Epub 2010 Jan 12.
Cholelithiasis and fatty liver disease share some important risk factors, such as central obesity, insulin resistance, and diabetes. We sought to determine whether persons with cholelithiasis or a history of cholecystectomy were more likely to have elevated serum liver enzymes or to develop cirrhosis.
We used cohort data from the first National Health and Nutrition Examination Survey (NHANES), to determine whether persons with a self-reported history of cholecystectomy at baseline (n=466) had a higher incidence of hospitalization or death due to cirrhosis than persons without a history of cholecystectomy (n=8,691) during up to 21 years of follow-up. We also used cross-sectional data from the third NHANES conducted between the years 1988 and 1994 to determine whether persons with cholelithiasis (n=833) or previous cholecystectomy (n=709), as determined by ultrasonography, were more likely to have elevated serum alanine aminotransferase (ALT) or gamma-glutamyl transferase (GGT) than persons without cholecystectomy or cholelithiasis (n=8,027).
Persons with previous cholecystectomy were two times more likely to be hospitalized for or die of cirrhosis (adjusted hazard ratio 2.1, 95% confidence interval (CI) 1.1-4.0) and were more likely to have elevated serum ALT (adjusted odds ratio 1.8, 95% CI 1.3-2.5) or GGT (adjusted odds ratio 1.7, 95% CI 1.1-2.6) than persons without cholecystectomy. We did not identify an independent association between cholelithiasis and serum ALT or GGT levels.
Cholecystectomy is a predictor of the development cirrhosis and is associated with elevated serum liver enzymes. Cholelithiasis is not independently associated with serum liver enzyme levels; whether cholelithiasis is associated with the development of cirrhosis remains to be determined.
胆石病和脂肪肝疾病有一些共同的重要危险因素，如中心性肥胖、胰岛素抵抗和糖尿病。我们旨在确定是否患有胆石病或曾接受胆囊切除术的人更有可能出现血清肝酶升高或发展为肝硬化。
我们使用了首次全国健康和营养调查（NHANES）的队列数据，以确定在 21 年的随访期间，基线时报告有胆囊切除术史（n=466）的人是否比无胆囊切除术史（n=8691）的人因肝硬化住院或死亡的发生率更高。我们还使用了 1988 年至 1994 年期间进行的第三次 NHANES 的横断面数据，以确定通过超声检查确定患有胆石病（n=833）或既往胆囊切除术（n=709）的人是否比无胆囊切除术或胆石病（n=8027）的人更有可能出现血清丙氨酸氨基转移酶（ALT）或γ-谷氨酰转移酶（GGT）升高。
既往有胆囊切除术的人因肝硬化住院或死亡的风险增加了两倍（调整后的危险比 2.1，95%置信区间[CI]1.1-4.0），并且更有可能出现血清 ALT（调整后的优势比 1.8，95%CI1.3-2.5）或 GGT（调整后的优势比 1.7，95%CI1.1-2.6）升高，与无胆囊切除术的人相比。我们没有发现胆石病与血清 ALT 或 GGT 水平之间存在独立关联。
胆囊切除术是肝硬化发生的预测因素，并与血清肝酶升高有关。胆石病与血清肝酶水平无独立关联；胆石病是否与肝硬化的发生有关仍有待确定。
