Center for Fatty Liver, Department of Gastroenterology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
The First Clinical School, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
Inflamm Bowel Dis. 2019 Oct 18;25(11):1764-1772. doi: 10.1093/ibd/izz043.
Nonalcoholic fatty liver disease (NAFLD) is increasingly identified in patients with inflammatory bowel disease (IBD), but there are few systematic reviews and meta-analyses of the studies of NAFLD in IBD patients.
MEDLINE, Web of Science, Cochrane Library, and Scopus were searched (until August 2018) to identify observational studies that reported the prevalence and risk factors for NAFLD in IBD patients. Pooled prevalence, odds ratios (OR), mean difference (MD), and 95% confidence intervals (95% CI) were calculated. Study quality was assessed using the modified Newcastle-Ottawa scale.
Of the 662 citations evaluated, 19 studies (including 5620 subjects) reported the prevalence of NAFLD in IBD population and were included for the analysis. The overall pooled prevalence was 27.5% (95% CI, 20.7%-34.2%). The prevalence was higher in older patients (MD = 8.22; 95% CI, 6.22-10.22), type 2 diabetes (OR = 3.85; 95% CI, 2.49-5.95), hypertension (OR = 3.18; 95% CI, 2.36-4.28), obesity (OR = 2.79; 95% CI, 1.73-4.50), insulin resistance (OR = 6.66; 95% CI, 1.28-34.77), metabolic syndrome (OR = 4.96; 95% CI, 3.05-8.05), chronic kidney disease (OR = 4.83; 95% CI, 1.79-13.04), methotrexate use (OR = 1.76; 95% CI, 1.02-3.06), surgery for IBD (OR = 1.28; 95% CI, 1.02-1.62), and longer duration of IBD (MD = 5.60; 95% CI, 2.24-8.97).
We found that NAFLD was not uncommon in the IBD population. Older age, metabolic risk factors, methotrexate use, prior surgery, and longer duration of IBD are predictors for the presence of NAFLD in IBD. Screening of NAFLD might be recommended among IBD patients with the aforementioned factors.
非酒精性脂肪性肝病（NAFLD）在炎症性肠病（IBD）患者中越来越多地被发现，但目前针对 IBD 患者 NAFLD 的研究还很少有系统评价和荟萃分析。
检索 MEDLINE、Web of Science、Cochrane 图书馆和 Scopus（截至 2018 年 8 月），以确定报告 IBD 患者中 NAFLD 患病率和危险因素的观察性研究。计算汇总患病率、比值比（OR）、均数差（MD）和 95%置信区间（95%CI）。使用改良的 Newcastle-Ottawa 量表评估研究质量。
在评估的 662 条引文中有 19 项研究（包括 5620 例患者）报告了 IBD 人群中 NAFLD 的患病率，并纳入分析。总体汇总患病率为 27.5%（95%CI，20.7%-34.2%）。年龄较大的患者（MD=8.22；95%CI，6.22-10.22）、2 型糖尿病（OR=3.85；95%CI，2.49-5.95）、高血压（OR=3.18；95%CI，2.36-4.28）、肥胖（OR=2.79；95%CI，1.73-4.50）、胰岛素抵抗（OR=6.66；95%CI，1.28-34.77）、代谢综合征（OR=4.96；95%CI，3.05-8.05）、慢性肾脏病（OR=4.83；95%CI，1.79-13.04）、甲氨蝶呤治疗（OR=1.76；95%CI，1.02-3.06）、IBD 手术（OR=1.28；95%CI，1.02-1.62）和 IBD 病程较长（MD=5.60；95%CI，2.24-8.97）的患者中 NAFLD 更为常见。
我们发现，IBD 患者中 NAFLD 并不少见。年龄较大、代谢危险因素、甲氨蝶呤治疗、既往手术和 IBD 病程较长是 IBD 患者存在 NAFLD 的预测因素。建议对具有上述因素的 IBD 患者进行 NAFLD 筛查。
