Division of Digestive and Liver Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA,
Division of Digestive and Liver Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA.
Dig Dis. 2020;38(3):222-230. doi: 10.1159/000502684. Epub 2019 Aug 30.
Nonalcoholic fatty liver disease (NAFLD) is the most common liver disorder worldwide. Previous studies have suggested an association between colorectal adenomas and NAFLD but are limited by a lack of biopsy-proven NAFLD or comparison with matched controls.
We aimed to determine whether histologically demonstrated NAFLD is an independent risk factor for colorectal adenomas.
Patients who underwent liver biopsy showing steatosis who had also undergone screening or surveillance colonoscopy in 2007-2017 were retrospectively studied by manual chart review, excluding patients with liver disease other than NAFLD. Adenoma detection rates and characteristics such as location, histologic type, and size were compared in the resulting 123 NAFLD patients against controls without liver disease matched by age, gender, and endoscopist.
Adenoma prevalence was significantly higher in the NAFLD group at 40.7 versus 28.1% in controls (OR 1.87, 95% CI 1.15-3.03, p = 0.01) and remained significant on multivariable analysis controlling for rates of hyperlipidemia, diabetes, and obesity (OR 1.74, 95% CI 1.05-2.88, p = 0.032). Comparing NAFLD patients with advanced fibrosis to those with simple steatosis, there was a trend toward higher adenoma prevalence in advanced fibrosis (50.0 vs. 36.8%; OR 1.84, 95% CI 0.50-6.70, p = 0.36).
Patients with histologically demonstrated NAFLD had a significantly higher adenoma prevalence on colonoscopy compared to matched controls, which remained significant after adjusting for rates of diabetes, obesity, and hyperlipidemia. NAFLD should be investigated further as an independent risk factor for colorectal neoplasia.
非酒精性脂肪性肝病（NAFLD）是全球最常见的肝脏疾病。先前的研究表明结直肠腺瘤与 NAFLD 之间存在关联，但由于缺乏活检证实的 NAFLD 或与匹配对照的比较，这些研究受到限制。
我们旨在确定组织学证实的 NAFLD 是否是结直肠腺瘤的独立危险因素。
通过手动病历回顾对 2007-2017 年接受过显示脂肪变性的肝活检且同时接受过筛查或监测结肠镜检查的患者进行回顾性研究，排除了除 NAFLD 以外的其他肝病患者。比较 123 例 NAFLD 患者与无肝病的对照组在腺瘤检出率和位置、组织学类型和大小等特征方面的差异，对照组按年龄、性别和内镜医师进行匹配。
NAFLD 组的腺瘤患病率明显高于对照组，分别为 40.7%和 28.1%（OR 1.87，95%CI 1.15-3.03，p = 0.01），并且在控制高脂血症、糖尿病和肥胖发生率后多变量分析仍具有显著性（OR 1.74，95%CI 1.05-2.88，p = 0.032）。比较伴有进展性纤维化和单纯脂肪变性的 NAFLD 患者，进展性纤维化患者的腺瘤患病率呈升高趋势（50.0%比 36.8%；OR 1.84，95%CI 0.50-6.70，p = 0.36）。
与匹配对照组相比，组织学证实的 NAFLD 患者结肠镜检查的腺瘤患病率明显更高，在调整糖尿病、肥胖和高脂血症的发生率后仍具有显著性。NAFLD 应作为结直肠肿瘤的独立危险因素进一步研究。
