Kakati Donny, Kumar Ujjwal, Russ Kirk, Shoreibah Mohamed, Kuo Yong-Fang, Jackson Bradford, Singal Ashwani K
Department of Medicine, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL, USA.
Division of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA.
Transl Gastroenterol Hepatol. 2020 Jan 5;5:3. doi: 10.21037/tgh.2019.09.03. eCollection 2020.
Cholecystectomy is a frequently performed surgical procedure for symptomatic cholelithiasis, which is reported to be more common in patients with non-alcoholic steatohepatitis (NASH), given the common risk factors. However, the data remains unclear on the association of cholecystectomy with NASH. We performed a retrospective study to examine the association of cholecystectomy and NASH.
Medical charts of patients with steatohepatitis related liver disease at a tertiary care center from 2004 to 2011 were stratified by cholecystectomy and defined by its history and/or absence of gallbladder on ultrasonography. Logistic regression model was built for predictors of cholecystectomy. Patients with NASH were stratified based on timing of cholecystectomy. The diagnosis of NASH and timing of cholecystectomy were compared based on baseline characteristics and outcomes (liver disease complications and survival) on follow up. Kaplan-Meier curves were generated for the two group comparisons. Chi-square and unpaired -tests were used for comparing outcomes on follow up. P value <0.05 was considered significant.
Analysis of 584 patients [379 non-alcoholic fatty liver disease (NAFLD)] showed that patients with cholecystectomy (N=191) were more likely to be female (57% . 44%), diabetic (53% . 37%), have liver biopsy (43% . 25%) and diagnosis of NAFLD (80% . 58%) P<0.001 for all. NAFLD diagnosis was associated with 2.79 folds odds of cholecystectomy. Among 379 (192 cholecystectomy) NAFLD patients, cirrhosis and female gender were associated with over 2 and 1.5 folds of cholecystectomy. Of 141 patients with data on timing of cholecystectomy, 55 (39%) with cholecystectomy at or after NAFLD diagnosis . 86 with cholecystectomy within median of 6 years prior to NAFLD diagnosis were similar on all characteristics except on model for end-stage liver disease (MELD) score (9.2±8.4 . 6.4±7.1, P=0.045). Of 28 with available histology data, there were no differences on histology based on timing of cholecystectomy. On a median follow up of 5 years, timing of cholecystectomy did not impact on development of cirrhosis (74% . 67%, P=0.45), ascites (31% . 38%, P=0.76), variceal bleeding (11% . 16%, P=0.44), hepatic encephalopathy (22% . 29%, P=0.74), hepatocellular carcinoma (HCC) (15% . 9%, P=0.59), and patient survival (95% . 98%, P=0.3).
Cholecystectomy is associated with NAFLD diagnosis. We did not find cause and effect of cholecystectomy in the development of severity of NAFLD. Prospective studies are suggested to examine the role of cholecystectomy and bile acids in the pathogenesis of NAFLD.
胆囊切除术是针对有症状胆结石经常实施的外科手术。鉴于共同的风险因素，据报道非酒精性脂肪性肝炎（NASH）患者中胆结石更为常见。然而，胆囊切除术与NASH之间的关联数据仍不明确。我们进行了一项回顾性研究以检验胆囊切除术与NASH之间的关联。
2004年至2011年在一家三级医疗中心患有脂肪性肝炎相关肝病患者的病历，根据胆囊切除术情况进行分层，并通过其病史和/或超声检查时胆囊的有无来确定。构建逻辑回归模型用于预测胆囊切除术。NASH患者根据胆囊切除术时间进行分层。基于基线特征和随访结果（肝病并发症和生存率）比较NASH的诊断和胆囊切除术时间。为两组比较生成Kaplan-Meier曲线。使用卡方检验和非配对t检验比较随访结果。P值<0.05被认为具有显著性。
对584例患者[379例非酒精性脂肪性肝病（NAFLD）]的分析显示，接受胆囊切除术的患者（N = 191）更可能为女性（57%对44%）、糖尿病患者（53%对37%）、接受肝活检（43%对25%）以及被诊断为NAFLD（80%对58%），所有这些P<0.001。NAFLD诊断与胆囊切除术的比值比为2.79。在379例（192例接受胆囊切除术）NAFLD患者中，肝硬化和女性性别与胆囊切除术的比值比分别超过2倍和1.5倍。在141例有胆囊切除术时间数据的患者中，55例（39%）在NAFLD诊断时或之后接受胆囊切除术，86例在NAFLD诊断前中位数6年内接受胆囊切除术，除终末期肝病模型（MELD）评分外（9.2±8.4对6.4±7.1，P = 0.045），所有特征均相似。在28例有可用组织学数据的患者中，基于胆囊切除术时间的组织学无差异。在中位随访5年时，胆囊切除术时间不影响肝硬化的发生（74%对67%，P = 0.45）、腹水（31%对38%，P = 0.76）、静脉曲张出血（11%对16%，P = 0.44）、肝性脑病（22%对29%，P = 0.74）、肝细胞癌（HCC）（15%对9%，P = 0.59）以及患者生存率（95%对98%，P = 0.3）。
胆囊切除术与NAFLD诊断相关。我们未发现胆囊切除术在NAFLD严重程度发展中的因果关系。建议进行前瞻性研究以检验胆囊切除术和胆汁酸在NAFLD发病机制中的作用。
