Veltkamp Claudia, Lan Shuai, Korompoki Eleni, Weiss Karl-Heinz, Schmidt Hartmut, Seitz Helmut K
Department of Gastroenterology, Hepatology and Transplantation Medicine, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany.
Department of Internal Medicine, Salem Hospital, 69121 Heidelberg, Germany.
J Clin Med. 2022 May 6;11(9):2623. doi: 10.3390/jcm11092623.
Background and Purpose: Chronic inflammatory bowel diseases (IBD) frequently affect extraintestinal organs including the liver. Since limited evidence suggests the presence of liver disease in IBD patients, we studied the frequency of hepatic steatosis and fibrosis in these patients and characterized disease-related factors. Methods: In this retrospective, cross-sectional, hospital-based, single-center study, consecutive patients with Crohn’s disease (CD) and ulcerative colitis (UC) were included who had undergone routine abdominal ultrasound including transhepatic elastography. Hepatic steatosis was diagnosed by hyperechogenicity on B-mode ultrasound and by measuring controlled attenuation parameter (CAP). Hepatic fibrosis was assumed if transhepatic elastography yielded a stiffness > 7 kPa. Results: 132 patients (60% CD) with a median disease duration of 10 years were included. Steatosis assessed by B-mode ultrasound and CAP correlated well. Of the IBD patients, 30.3% had non-alcoholic fatty liver (NAFL). Factors associated with NAFL were age, BMI, duration of disease, as well as serum activities of aspartate-aminotransferase (AST) and gamma-glutamyl-transpeptidase (GGT). In multivariate analysis, only disease duration was independently associated with hepatic steatosis. Hepatic fibrosis was found in 10 (8%) of all IBD patients, predominantly in patients with CD (10/11). Conclusions: Pure hepatic steatosis is common in both CD and UC, whereas hepatic fibrosis occurs predominantly in CD patients. Association of disease duration with NAFLD suggests a contribution of IBD-related pathogenetic factors. Longitudinal studies are needed to better understand the impact of IBD on hepatic disorders.
慢性炎症性肠病（IBD）常累及包括肝脏在内的肠外器官。由于仅有有限的证据提示IBD患者存在肝脏疾病，我们研究了这些患者肝脂肪变性和肝纤维化的发生率，并对疾病相关因素进行了特征分析。方法：在这项基于医院的单中心回顾性横断面研究中，纳入了连续的克罗恩病（CD）和溃疡性结肠炎（UC）患者，这些患者均接受了包括经肝弹性成像的常规腹部超声检查。通过B型超声上的高回声性以及测量受控衰减参数（CAP）来诊断肝脂肪变性。如果经肝弹性成像得出的硬度>7 kPa，则假定存在肝纤维化。结果：纳入了132例患者（60%为CD），疾病中位病程为10年。通过B型超声和CAP评估的脂肪变性相关性良好。在IBD患者中，30.3%患有非酒精性脂肪性肝病（NAFL）。与NAFL相关的因素包括年龄、体重指数、病程以及天冬氨酸转氨酶（AST）和γ-谷氨酰转肽酶（GGT）的血清活性。在多变量分析中，仅病程与肝脂肪变性独立相关。在所有IBD患者中，10例（8%）发现有肝纤维化，主要见于CD患者（10/11）。结论：单纯性肝脂肪变性在CD和UC中均很常见，而肝纤维化主要发生于CD患者。病程与NAFLD的关联提示IBD相关致病因素的作用。需要进行纵向研究以更好地了解IBD对肝脏疾病的影响。
