Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
Sci Rep. 2021 Oct 7;11(1):19954. doi: 10.1038/s41598-021-98843-7.
Despite the known functional relationship between the gut and the liver, the clinical consequences of this circuit remain unclear. We assessed the hepatobiliary phenotype of cohorts with celiac disease (CeD), Crohn´s disease (CD) and ulcerative colitis (UC). Baseline liver function tests and the frequency of hepatobiliary diseases were analyzed in 2377 CeD, 1738 CD, 3684 UC subjects and 488,941 controls from the population-based UK Biobank cohort. In this cohort study associations were adjusted for age, sex, BMI, diabetes, and alcohol consumption. Compared to controls, cohorts with CeD, but not CD/UC displayed higher AST/ALT values. Subjects with CD/UC but not CeD had increased GGT levels. Elevated ALP and cholelithiasis were significantly more common in all intestinal disorders. Non-alcoholic steatohepatitis and hepatocellular carcinoma (HCC) were enriched in CeD and CD (NASH: aOR = 4.9 [2.2-11.0] in CeD, aOR = 4.2 [1.7-10.3] in CD, HCC: aOR = 4.8 [1.8-13.0] in CeD, aOR = 5.9 [2.2-16.1] in CD), while cholangitis was more common in the CD/UC cohorts (aOR = 11.7 [9.1-15.0] in UC, aOR = 3.5 [1.8-6.8] in CD). Chronic hepatitis, autoimmune hepatitis (AIH) and cirrhosis were more prevalent in all intestinal disorders. In UC/CD, a history of intestinal surgery was associated with elevated liver enzymes and increased occurrence of gallstones (UC: aOR = 2.9 [2.1-4.1], CD: 1.7 [1.2-2.3]). Our data demonstrate that different intestinal disorders predispose to distinct hepatobiliary phenotypes. An increased occurrence of liver cirrhosis, NASH, AIH and HCC and the impact of surgery warrant further exploration.
尽管已知肠道和肝脏之间存在功能关系，但该回路的临床后果仍不清楚。我们评估了乳糜泻（CeD）、克罗恩病（CD）和溃疡性结肠炎（UC）患者的肝胆表型。在基于人群的英国生物库队列中，对 2377 例 CeD、1738 例 CD、3684 例 UC 患者和 488941 名对照者进行了基线肝功能检查和肝胆疾病频率分析。在这项队列研究中，调整了年龄、性别、BMI、糖尿病和饮酒因素。与对照组相比，CeD 组而非 CD/UC 组的 AST/ALT 值更高。CD/UC 组的 GGT 水平升高。所有肠道疾病中，碱性磷酸酶（ALP）升高和胆石症更为常见。非酒精性脂肪性肝炎（NASH）和肝细胞癌（HCC）在 CeD 和 CD 中更为常见（NASH：CeD 中的优势比[OR]为 4.9[2.2-11.0]，CD 中的 OR 为 4.2[1.7-10.3]，HCC：CeD 中的 OR 为 4.8[1.8-13.0]，CD 中的 OR 为 5.9[2.2-16.1]），而胆管炎在 CD/UC 队列中更为常见（UC 中的 OR 为 11.7[9.1-15.0]，CD 中的 OR 为 3.5[1.8-6.8]）。慢性肝炎、自身免疫性肝炎（AIH）和肝硬化在所有肠道疾病中更为常见。在 UC/CD 中，肠道手术史与肝酶升高和胆结石发生率增加有关（UC：OR 为 2.9[2.1-4.1]，CD：1.7[1.2-2.3]）。我们的数据表明，不同的肠道疾病易导致不同的肝胆表型。肝硬化、NASH、AIH 和 HCC 的发生率增加以及手术的影响值得进一步探讨。
