2 型糖尿病患者的胆石病和非酒精性脂肪性肝病：一项横断面研究。
Gallstone disease and nonalcoholic fatty liver disease in patients with type 2 diabetes: a cross-sectional study.
机构信息
Department of Endocrinology and Metabolism, Shanghai Eighth People's Hospital, Shanghai, 200235, China.
Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Diabetes Institute, Shanghai, 200233, China.
出版信息
BMC Endocr Disord. 2021 Nov 19;21(1):231. doi: 10.1186/s12902-021-00899-z.
BACKGROUND
Nonalcoholic fatty liver disease (NAFLD) and gallstone disease (GSD) often coexist in the general population owing to shared risk factors. This study explored the relationship between NAFLD and GSD in patients with type 2 diabetes.
METHODS
We conducted a retrospective cross-sectional analysis of 4325 patients with type 2 diabetes. GSD and NAFLD were confirmed using ultrasonography. GSD was defined as either asymptomatic gallstones or previous cholecystectomy, and each was analyzed separately.
RESULT
There was no significant difference in the prevalence of GSD between patients with and without NAFLD (23.8% vs. 21.2%, P = 0.15). After case-control matching (1:1) of baseline data such as age, sex, duration of diabetes, and HbA1c between patients with and without NAFLD, there was still no significant difference in the prevalence of GSD (25.5% vs. 23.6%, P = 0.15). The prevalence of NAFLD in patients with asymptomatic gallstones was lower than that of patients without GSD (38.6% vs. 47.3%, P < 0.001), whereas the prevalence in those who had undergone cholecystectomy was much higher (61.2% vs. 47.3%, P < 0.001). The ratio of cholecystectomy to asymptomatic gallstone in patients with or without NAFLD was 1.97 and 0.79, respectively. The rate of cholecystectomy was higher in the patients with NAFLD than in those without NAFLD (15.8% vs. 9.3%, P < 0.001), consistent with the result after case-control matching (17.3% vs. 11.2%, P < 0.001). Multivariate logistic regression analysis, after adjusting for numerous potential confounding factors, revealed that GSD (OR = 1.241, 95%CI: 1.036-1.488, P = 0.002) and cholecystectomy (OR = 1.946, 95%CI: 1.546-2.445, P < 0.001) were both strongly associated with NAFLD. However, asymptomatic gallstone (OR = 0.663, 95%CI: 0.513-0.856, P = 0.002) seemed to be negatively correlated with NAFLD.
CONCLUSIONS
The prevalence of GSD was similar in patients with type 2 diabetes with and without NAFLD. The higher proportion of cholecystectomy and lower proportion of asymptomatic gallstones in patients with NAFLD suggests that NAFLD may increase the risk of complications of GSD.
背景
非酒精性脂肪性肝病 (NAFLD) 和胆石病 (GSD) 常因共同的危险因素而在普通人群中同时存在。本研究探讨了 2 型糖尿病患者中 NAFLD 与 GSD 之间的关系。
方法
我们对 4325 例 2 型糖尿病患者进行了回顾性横断面分析。使用超声检查确认 GSD 和 NAFLD。GSD 定义为无症状胆囊结石或既往胆囊切除术，分别进行分析。
结果
NAFLD 患者与无 NAFLD 患者的 GSD 患病率无显著差异（23.8% vs. 21.2%，P=0.15）。在对有和无 NAFLD 的患者进行年龄、性别、糖尿病病程和 HbA1c 等基线数据的病例对照匹配（1:1）后，GSD 的患病率仍无显著差异（25.5% vs. 23.6%，P=0.15）。无症状胆囊结石患者的 NAFLD 患病率低于无 GSD 的患者（38.6% vs. 47.3%，P<0.001），而接受胆囊切除术的患者则高得多（61.2% vs. 47.3%，P<0.001）。有或无 NAFLD 的患者中胆囊切除术与无症状胆囊结石的比值分别为 1.97 和 0.79。有 NAFLD 的患者胆囊切除术的比例高于无 NAFLD 的患者（15.8% vs. 9.3%，P<0.001），与病例对照匹配后的结果一致（17.3% vs. 11.2%，P<0.001）。多变量 logistic 回归分析显示，在调整了多种潜在混杂因素后，GSD（OR=1.241，95%CI：1.036-1.488，P=0.002）和胆囊切除术（OR=1.946，95%CI：1.546-2.445，P<0.001）与 NAFLD 均呈强相关。然而，无症状胆囊结石（OR=0.663，95%CI：0.513-0.856，P=0.002）与 NAFLD 似乎呈负相关。
结论
2 型糖尿病患者中 NAFLD 与 GSD 的患病率相似。有 NAFLD 的患者胆囊切除术的比例较高，而无症状胆囊结石的比例较低，提示 NAFLD 可能增加 GSD 并发症的风险。
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