Singh Kaptan, Dahiya Divya, Kaman Lileswar, Das Ashim
Department of Surgery, PGIMER, Chandigarh, India.
Department of Histopathology, PGIMER Chandigarh, India.
Pol Przegl Chir. 2019 Nov 15;92(1):18-22. doi: 10.5604/01.3001.0013.5660.
Gallstone disease (GSD) and nonalcoholic fatty liver disease (NAFLD) are connected with a high prevalence in the general population and they share common risk factors for their occurrence. Limited literature with inconsistent results is available, suggesting a potential association between these lifestyle-induced diseases. Liver biopsy is the gold standard for diagnosing NAFLD. The aim of this study was (1) to identify the prevalence of asymptomatic NAFLD or NASH in liver biopsy; (2) to identify the association of hypercholesterolemia with NAFLD in patients undergoing laparoscopic cholecystectomy (LC).
This is a prospective observational study conducted on patients who underwent LC for symptomatic gallstones in the Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India, from 1st July 2013 to 31st December 2014. All included patients had ultrasonography (USG) and the following parameters tested: serum triglycerides (TG), cholesterol, low density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). A wedge liver biopsy was obtained from free edge of the right liver lobe during LC and all biopsy specimens were analyzed by a single pathologist.
Among 101 patients included in the study, dyslipidemia was present in 49.50%. There was no association between NAFLD and serum cholesterol, TG or LDL-C (P, 0.428, 0.848, 0.371 respectively). NAFLD was confirmed in liver biopsy in 21.8% of patients but none had fibrosis or cirrhosis on biopsy. No complications were observed following liver biopsy.
Liver biopsy during LC gives an opportunity to diagnose the disease at an early and reversible stage. It is feasible, safe and cost effective.
胆结石病（GSD）和非酒精性脂肪性肝病（NAFLD）在普通人群中具有较高的患病率，且它们有共同的发病风险因素。现有文献有限且结果不一致，提示这些生活方式导致的疾病之间可能存在关联。肝活检是诊断NAFLD的金标准。本研究的目的是：（1）确定肝活检中无症状NAFLD或非酒精性脂肪性肝炎（NASH）的患病率；（2）确定在接受腹腔镜胆囊切除术（LC）的患者中高胆固醇血症与NAFLD的关联。
这是一项前瞻性观察性研究，研究对象为2013年7月1日至2014年12月31日在印度昌迪加尔医学教育与研究研究生院普通外科因有症状胆结石接受LC的患者。所有纳入的患者均接受了超声检查（USG）并检测了以下参数：血清甘油三酯（TG）、胆固醇、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）。在LC期间从右肝叶的游离边缘获取楔形肝活检组织，所有活检标本由一名病理学家进行分析。
在纳入研究的101例患者中，血脂异常的发生率为49.50%。NAFLD与血清胆固醇、TG或LDL-C之间无关联（P值分别为0.428、0.848、0.371）。21.8%的患者肝活检确诊为NAFLD，但活检时均无纤维化或肝硬化。肝活检后未观察到并发症。
LC期间进行肝活检为在疾病的早期和可逆阶段进行诊断提供了机会。它是可行、安全且具有成本效益的。
