美国住院患者人群中非酒精性脂肪性肝病与胆结石病的关联。
Association of non-alcoholic fatty liver disease with gallstone disease in the United States hospitalized patient population.
作者信息
Kichloo Asim, Solanki Shantanu, Haq Khwaja F, Dahiya Dushyant, Bailey Beth, Solanki Dhanshree, Singh Jagmeet, Albosta Michael, Wani Farah, Aljadah Michael, Shah Harshil, Khan Hafiz, Jafri Syed-Mohammed
机构信息
Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI 48602, United States.
Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA 18840, United States.
出版信息
World J Gastrointest Pathophysiol. 2021 Mar 22;12(2):14-24. doi: 10.4291/wjgp.v12.i2.14.
BACKGROUND
Gallstones and cholecystectomy have been proposed as risk factors for non-alcoholic fatty liver disease (NAFLD). The reason for this may be that both gallstones, as well as NAFLD share several risk factors with regards to their development. Currently, there is a lack of sufficient evidence showing an association between these clinical conditions.
AIM
To determine whether there is a meaningful association between gallstones and cholecystectomy with NAFLD.
METHODS
We queried the National Inpatient Sample database from the years 2016 and 2017 using International Classification of Diseases, 10 revision, Clinical Modification diagnosis codes to identify hospitalizations with a diagnosis of gallstone disease (GSD) (includes calculus of gallbladder without cholecystitis without obstruction and acquired absence of gallbladder) as well as NAFLD (includes simple fatty liver and non-alcoholic steatohepatitis). Odds ratios (ORs) measuring the association between GSD (includes gallstones and cholecystectomy) and NAFLD were calculated using logistic regression after adjusting for confounding variables.
RESULTS
Out of 14294784 hospitalizations in 2016-2017, 159259 were found to have NAFLD. The prevalence of NAFLD was 3.3% in patients with GSD and 1% in those without. NAFLD was prevalent in 64.3% of women with GSD as compared to 35.7% of men with GSD. After controlling for various confounders associated with NAFLD and GSD, multivariate-adjusted analysis showed that there was an association between NAFLD with gallstones [OR = 6.32; 95% confidence interval (CI): 6.15-6.48] as well as cholecystectomy (OR = 1.97; 95%CI: 1.93-2.01). The association between NAFLD and gallstones was stronger in men (OR = 6.67; 95%CI: 6.42-6.93) than women (OR = 6.05; 95%CI: 5.83-6.27). The association between NAFLD and cholecystectomy was stronger in women (OR = 2.01; 95%CI: 1.96-2.06) than men (OR = 1.85; 95%CI: 1.79-1.92). value was less than 0.001 for all comparisons.
CONCLUSION
NAFLD is more prevalent in women with GSD than men. The association between NAFLD and cholecystectomy/gallstones indicates that they may be risk factors for NAFLD.
背景
胆结石和胆囊切除术被认为是非酒精性脂肪性肝病（NAFLD）的危险因素。其原因可能是胆结石以及NAFLD在发病方面有若干共同的危险因素。目前，缺乏足够证据表明这些临床情况之间存在关联。
目的
确定胆结石及胆囊切除术与NAFLD之间是否存在有意义的关联。
方法
我们使用国际疾病分类第10版临床修订本诊断编码查询了2016年和2017年的国家住院患者样本数据库，以识别诊断为胆结石病（GSD）（包括无胆囊炎无梗阻的胆囊结石以及后天性胆囊缺失）以及NAFLD（包括单纯性脂肪肝和非酒精性脂肪性肝炎）的住院病例。在对混杂变量进行校正后，使用逻辑回归计算测量GSD（包括胆结石和胆囊切除术）与NAFLD之间关联的比值比（OR）。
结果
在2016 - 2017年的14294784例住院病例中，发现159259例患有NAFLD。GSD患者中NAFLD的患病率为3.3%，无GSD患者中为1%。GSD女性患者中NAFLD患病率为64.3%，而GSD男性患者中为35.7%。在控制了与NAFLD和GSD相关的各种混杂因素后，多变量校正分析表明，NAFLD与胆结石之间存在关联[OR = 6.32；95%置信区间（CI）：6.15 - 6.48]以及与胆囊切除术之间存在关联（OR = 1.97；95%CI：1.93 - 2.01）。NAFLD与胆结石之间的关联在男性中（OR = 6.67；95%CI：6.42 - 6.93）比女性中（OR = 6.05；95%CI：5.83 - 6.27）更强。NAFLD与胆囊切除术之间的关联在女性中（OR = 2.01；95%CI：1.96 - 2.06）比男性中（OR = 1.85；95%CI：1.79 - 1.92）更强。所有比较的P值均小于0.001。
结论
GSD女性患者中NAFLD比男性更普遍。NAFLD与胆囊切除术/胆结石之间的关联表明它们可能是NAFLD的危险因素。
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