Rodriguez-Duque Juan Carlos, Calleja José Luis, Iruzubieta Paula, Hernández-Conde Marta, Rivas-Rivas Coral, Vera María Isabel, Garcia Maria Jose, Pascual Marta, Castro Beatriz, García-Blanco Agustín, García-Nieto Enrique, Olmo Soraya Curiel-Del, Cagigal María Luisa, Lopez-Montejo Lorena, Fernández-Lamas Tatiana, Rasines Laura, Fortea José Ignacio, Vaque José Pedro, Frias Yza, Rivero Montserrat, Arias-Loste María Teresa, Crespo Javier
Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, Santander, Spain; Group of Clinical and Translational Research in Digestive Diseases Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), Santander, Spain.
Gastroenterology and Hepatology Department, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain.
Clin Gastroenterol Hepatol. 2023 Feb;21(2):406-414.e7. doi: 10.1016/j.cgh.2022.01.039. Epub 2022 Feb 3.
BACKGROUND & AIMS: There is conflicting evidence regarding the prevalence of and risk factors for metabolic-associated fatty liver disease (MAFLD) in patients with inflammatory bowel disease (IBD). We aimed to determine MAFLD prevalence and risk factors in IBD patients.
Cross-sectional, case-control study included all consecutive IBD patients treated at 2 different university hospitals. Controls were subjects randomly selected from the general population and matched by age, sex, type 2 diabetes status, and body mass index in a 1:2 ratio. MAFLD was confirmed by controlled attenuation parameter. Liver biopsies were collected when MAFLD with significant liver fibrosis was suspected. In addition, age- and fibrosis stage-paired non-IBD patients with biopsy-proven MAFLD served as a secondary control group.
Eight hundred thirty-one IBD patients and 1718 controls were included. The prevalence of MAFLD and advanced liver fibrosis (transient elastography ≥9.7 kPa) was 42.00% and 9.50%, respectively, in IBD patients and 32.77% and 2.31%, respectively, in the general population (P < .001). A diagnosis of IBD was an independent predictor of MAFLD (adjusted odds ratio, 1.99; P < .001) and an independent risk factor for advanced liver fibrosis (adjusted odds ratio, 5.55; P < .001). Liver biopsies were obtained from 40 IBD patients; MAFLD was confirmed in all cases, and fibrosis of any degree was confirmed in 25 of 40 cases (62.5%). Body mass index and type 2 diabetes prevalence were significantly lower in IBD-MAFLD patients than in severity-paired patients with biopsy-proven MAFLD.
MAFLD and liver fibrosis are particularly prevalent in IBD patients, regardless of the influence of classic metabolic risk factors.
关于炎症性肠病（IBD）患者中代谢相关脂肪性肝病（MAFLD）的患病率及危险因素，证据存在冲突。我们旨在确定IBD患者中MAFLD的患病率及危险因素。
横断面病例对照研究纳入了在两家不同大学医院接受治疗的所有连续IBD患者。对照组是从普通人群中随机选取的，按年龄、性别、2型糖尿病状态和体重指数以1:2的比例进行匹配。通过受控衰减参数确诊MAFLD。当怀疑MAFLD伴有显著肝纤维化时，进行肝活检。此外，年龄和纤维化阶段匹配的经活检证实为MAFLD的非IBD患者作为第二对照组。
纳入了831例IBD患者和1718例对照组。IBD患者中MAFLD和晚期肝纤维化（瞬时弹性成像≥9.7 kPa）的患病率分别为42.00%和9.50%，普通人群中分别为32.77%和2.31%（P <.001）。IBD诊断是MAFLD的独立预测因素（校正比值比，1.99；P <.001），也是晚期肝纤维化的独立危险因素（校正比值比，5.55；P <.001）。从40例IBD患者中获取了肝活检样本；所有病例均确诊为MAFLD，40例中有25例（62.5%）确诊有任何程度的纤维化。IBD-MAFLD患者的体重指数和2型糖尿病患病率显著低于经活检证实为MAFLD的病情严重程度匹配患者。
无论经典代谢危险因素的影响如何，MAFLD和肝纤维化在IBD患者中尤其普遍。
