Department of Internal Medicine, Centro Studi Malattie Metaboliche del Fegato, University of Milano, Maggiore Policlinico Hospital, IRCCS Ca' Granda Foundation, Milano, Italy.
PLoS One. 2012;7(7):e41183. doi: 10.1371/journal.pone.0041183. Epub 2012 Jul 25.
Nonalcoholic fatty liver disease (NAFLD) and gallstone disease (GD) are both highly prevalent in the general population and associated with obesity and insulin resistance. We aimed to evaluate the prevalence of GD in a cross sectional study of NAFLD patients and to define whether the presence of GD is associated with diabetes and predicts more severe liver disease.
METHODOLOGY/PRINCIPAL FINDINGS: We merged databases of four Liver Units, comprising 524 consecutive biopsy-proven NAFLD (373 males) observed between January 2003 and June 2010. GD was diagnosed in 108 (20%), and 313 cases (60%) were classified by liver biopsy as nonalcoholic steatohepatitis (NASH). The GD subgroup was characterized by a significantly higher prevalence of females, prediabetes/diabetes, abdominal obesity and metabolic syndrome, older age, higher BMI, fasting glucose, HOMA-IR and lower ALT. The prevalence of GD progressively increased with advancing fibrosis and with the severity of necroinflammatory activity (p for trend = 0.0001 and = 0.01, respectively), without differences in the severity of steatosis. At multivariate analysis GD was associated with female gender (OR 1.37, 95% CI 1.04-1.8), age (OR 1.027, 95% CI1.003-1.05), fasting glucose (OR 1.21, 95% CI 1.10-1.33) and NASH (OR 1.40,95% CI 1.06-1.89), whereas ALT levels were associated with a lower GD risk (OR 0.98, 95% CI 0.97-0.99). When subjects with cirrhosis were excluded from analysis, the association between GD and fasting glucose, female gender, and NASH was maintained.
Patients with NAFLD have a high prevalence of GD, which characterizes subjects with altered glucose regulation and more advanced liver disease.
非酒精性脂肪性肝病（NAFLD）和胆石病（GD）在普通人群中都非常普遍，与肥胖和胰岛素抵抗有关。我们旨在评估 NAFLD 患者的 GD 患病率，并确定 GD 的存在是否与糖尿病有关，并预测更严重的肝病。
方法/主要发现：我们合并了四个肝脏单位的数据库，包括 2003 年 1 月至 2010 年 6 月期间观察到的 524 例经活检证实的 NAFLD（373 名男性）。诊断出 108 例（20%）GD，313 例（60%）病例根据肝活检分类为非酒精性脂肪性肝炎（NASH）。GD 亚组的女性、前驱糖尿病/糖尿病、腹部肥胖和代谢综合征、年龄较大、BMI 较高、空腹血糖、HOMA-IR 和较低的 ALT 患病率明显更高。随着纤维化和坏死性炎症活动程度的加重，GD 的患病率逐渐增加（趋势检验的 p 值分别为 0.0001 和 0.01），而脂肪变性的严重程度没有差异。多变量分析显示，GD 与女性性别（比值比 1.37，95%置信区间 1.04-1.8）、年龄（比值比 1.027，95%置信区间 1.003-1.05）、空腹血糖（比值比 1.21，95%置信区间 1.10-1.33）和 NASH（比值比 1.40，95%置信区间 1.06-1.89）有关，而 ALT 水平与 GD 风险降低有关（比值比 0.98，95%置信区间 0.97-0.99）。当排除分析中的肝硬化患者时，GD 与空腹血糖、女性性别和 NASH 之间的关联仍然存在。
NAFLD 患者 GD 的患病率很高，这一特征表明患者的葡萄糖调节发生改变，且肝病更为严重。
