[非酒精性脂肪性肝病与胆石病共病病程的临床特征]

[Clinical features of the comorbid course of non-alcoholic fatty liver disease and gallstone disease].

作者信息

Cherkashchenko N A, Livzan M A, Krolevets T S

机构信息

West Siberian Medical Center.

Omsk State Medical University.

出版信息

Ter Arkh. 2020 Sep 3;92(8):29-36. doi: 10.26442/00403660.2020.08.000764.

DOI:10.26442/00403660.2020.08.000764

PMID:33346459

Abstract

AIM

To determine the diagnostic value of clinical features of the comorbid course of non-alcoholic fatty liver disease (NAFLD) and gallstone disease (GD) to improve the effectiveness of patient management.

MATERIALS AND METHODS

183 patients with NAFLD were included into the open comparative study. The main group was represented by patients with NAFLD and GD (n=88), of which 53 patients underwent cholecystectomy (CE). The comparison group was represented by patients with NAFLD without GD (n=95). A standard laboratory and instrumental examinations were performed, including elastometry to assess of the stage of liver fibrosis.

RESULTS

There were more women in the main group (2=8.48; p0.01). There were positive correlations between the age of patients and the duration of NAFLD with the presence of GD and CE (rs=0.135; p0.01 and rs=0.168; p0.01 respectively). Patients of the main group had the general weakness and fatigue (2=11.33, rs=0.234; p0.01 and 2=15.68, rs=0.281; p0.01 respectively), as well as a bitter taste in the mouth (2=11.66; p0.01; rs=0.147; p0.01). Coronary heart disease was diagnosed more often among people suffering from NAFLD and GD (25% vs 9.47% in patients of the comparison group, p0.01). Both of NAFLD and GD were associated with the development of type 2 diabetes (rs=0.164; p0.01). Individuals suffering from GD after CE had higher LDL and GGT values (rs=0.228; p0.01 and rs=0.298; p0.01 respectively). The number of people with advanced fibrosis were significantly higher (26.31%) in the GD group, especially among people after CE (30.18%). The stage of liver fibrosis had a positive significant relationship with CE (rs=0.366; p0.01).

CONCLUSION

Patients suffering from GD and NAFLD had a symptom of dyspepsia and general weakness. High prevalence of type 2 diabetes and сoronary heart disease, high level of LDL and GGT were found in patients with GD and after CE. CE in patients suffering from GD and NAFLD was associated with the formation of progressive stages of liver fibrosis.

摘要

目的

确定非酒精性脂肪性肝病（NAFLD）与胆结石病（GD）合并病程的临床特征的诊断价值，以提高患者管理的有效性。

材料与方法

183例NAFLD患者纳入开放性对照研究。主要组由患有NAFLD和GD的患者组成（n = 88），其中53例患者接受了胆囊切除术（CE）。对照组由无GD的NAFLD患者组成（n = 95）。进行了标准的实验室和仪器检查，包括弹性测定法以评估肝纤维化阶段。

结果

主要组女性更多（χ² = 8.48；p < 0.01）。患者年龄和NAFLD病程与GD和CE的存在呈正相关（rs = 0.135；p < 0.01和rs = 0.168；p < 0.01）。主要组患者有全身无力和疲劳感（χ² = 11.33，rs = 0.234；p < 0.01和χ² = 15.68，rs = 0.281；p < 0.01），以及口苦（χ² = 11.66；p < 0.01；rs = 0.147；p < 0.01）。在患有NAFLD和GD的人群中，冠心病的诊断更为常见（25% 对对照组患者的9.47%，p < 0.01）。NAFLD和GD均与2型糖尿病的发生有关（rs = 0.164；p < 0.01）。CE后患有GD的个体的低密度脂蛋白（LDL）和γ-谷氨酰转移酶（GGT）值较高（rs = 0.228；p < 0.01和rs = 0.298；p < 0.01）。GD组中晚期纤维化患者的数量显著更高（26.31%），尤其是CE后的人群（30.18%）。肝纤维化阶段与CE呈显著正相关（rs = 0.366；p < 0.01）。