Bosch Dustin E, Yeh Matthew M
Department of Pathology, University of Washington School of Medicine, Seattle, WA 98195.
Department of Pathology, University of Washington School of Medicine, Seattle, WA 98195; Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195.
Hum Pathol. 2017 Nov;69:55-62. doi: 10.1016/j.humpath.2017.09.008. Epub 2017 Sep 29.
Nonalcoholic fatty liver disease (NAFLD) occurs with higher prevalence in patients with inflammatory bowel disease (IBD) relative to the general population, and susceptibility is related to the metabolic syndrome, as well as higher prevalence of bowel resection and gut microbiotal factors. Liver complications, including NAFLD and primary sclerosing cholangitis (PSC), contribute to treatment and prognosis of patients with IBD. However, the potential interplay of NAFLD and PSC is not well understood. We retrospectively assessed severity of steatosis and steatohepatitis in liver specimens from 49 patients with IBD only, 44 with IBD and comorbid PSC, and 30 with IBD and PSC after liver transplantation. Patients with IBD had higher prevalence of at least grade 1 steatosis (59%) than IBD and PSC (11%), or IBD and PSC posttransplant (3%) (P < .001). The average severity of steatosis was 25% ± 8% (95% confidence interval) for IBD only, 3% ± 1% for comorbid IBD and PSC, and 1% ± 1% for IBD and PSC posttransplant (P < .001). Steatohepatitis was significantly higher in IBD only (12%) than in IBD and PSC ± transplant (0%) (P = .01). Despite these differences in susceptibility to NAFLD, the 3 populations had statistically indistinguishable average body mass index and total cholesterol and prevalence of hypertension, diabetes, and alcohol use. Multivariate regression modeling revealed body mass index, hypertension, and diabetes as significant correlates to NAFLD severity in all studied populations. In conclusion, patients with comorbid IBD and PSC have significantly less susceptibility to NAFLD than those with IBD alone, despite similar prevalence of major NAFLD risk factors.
与普通人群相比，非酒精性脂肪性肝病（NAFLD）在炎症性肠病（IBD）患者中的患病率更高，其易感性与代谢综合征、更高的肠切除术患病率以及肠道微生物群因素有关。包括NAFLD和原发性硬化性胆管炎（PSC）在内的肝脏并发症会影响IBD患者的治疗和预后。然而，NAFLD和PSC之间的潜在相互作用尚不清楚。我们回顾性评估了49例仅患有IBD、44例患有IBD合并PSC以及30例肝移植后患有IBD和PSC的患者肝脏标本中的脂肪变性和脂肪性肝炎的严重程度。IBD患者中至少1级脂肪变性的患病率（59%）高于IBD合并PSC患者（11%）或肝移植后IBD合并PSC患者（3%）（P <.001）。仅患有IBD的患者脂肪变性的平均严重程度为25%±8%（95%置信区间），IBD合并PSC患者为3%±1%，肝移植后IBD合并PSC患者为1%±1%（P <.001）。仅患有IBD的患者中脂肪性肝炎的发生率（12%）显著高于IBD合并PSC±移植患者（0%）（P =.01）。尽管在NAFLD易感性方面存在这些差异，但这三组人群的平均体重指数、总胆固醇以及高血压、糖尿病和饮酒的患病率在统计学上无显著差异。多变量回归模型显示，体重指数、高血压和糖尿病是所有研究人群中与NAFLD严重程度显著相关的因素。总之，尽管主要NAFLD危险因素的患病率相似，但IBD合并PSC患者对NAFLD的易感性明显低于单纯IBD患者。
