Koller Tomas, Kollerova Jana, Hlavaty Tibor, Huorka Martin, Payer Juraj
5th Internal Medicine Department, Comenius University Medical School, University Hospital Bratislava, Bratislava, Slovakia.
Scand J Gastroenterol. 2012 Feb;47(2):197-203. doi: 10.3109/00365521.2011.643481. Epub 2011 Dec 19.
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 identify 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.
胆结石与非酒精性脂肪性肝病（NAFLD）具有相同的风险因素。我们研究的目的是探讨这两种疾病之间的关系，并在一组具有代谢风险因素的患者中确定这两种疾病的独立预测因素。纳入了在一年期间转诊至门诊的连续的具有代谢风险因素的患者。胆结石的定义为在纳入研究时腹部超声检查发现胆结石或既往有胆囊切除术史。NAFLD的定义为存在至少一种替代指标，如丙氨酸氨基转移酶和/或γ-谷氨酰转肽酶升高和/或脂肪肝的超声征象。其他常见肝病被彻底排除。确定了有和没有NAFLD的患者中胆结石的患病率，并通过多因素逻辑回归确定临床和实验室参数为NAFLD的预测因素。总共纳入了482例连续患者：平均年龄61岁；61%为女性；52%的患者有超过2种代谢风险因素（肥胖、2型糖尿病、高血压、高甘油三酯血症或低高密度脂蛋白胆固醇）。所有患者中，NAFLD和胆结石的患病率分别为41%和34%。与没有NAFLD的患者相比，NAFLD患者中胆结石的患病率显著更高（分别为47%和26%；p<0.0001）。在多因素逻辑回归模型中，2型糖尿病（比值比（OR）=1.99）、体重指数高于25kg/m²（OR = 1.78）和胆结石（OR = 1.77）被确定为NAFLD的独立预测因素。有胆结石的患者中56%患有NAFLD，而没有胆结石的患者中这一比例为33%（p<0.0001）。多因素逻辑回归确定年龄超过50岁（OR = 3.46）、NAFLD（OR = 1.92）、甘油三酯高于1.7mmol/L（OR = 1.91）、体重指数高于25kg/m²（OR = 1.84）和总胆固醇浓度（OR = 0.711）为胆结石的独立预测因素。总之，与参照组相比，具有代谢风险因素和胆结石的患者患NAFLD的频率显著更高。除代谢风险因素外，胆结石是NAFLD的独立风险因素，可被视为NAFLD患者肝损伤的额外风险因素。此外，NAFLD是胆结石的独立风险因素，可能代表代谢综合征与胆结石之间的发病机制联系。
