Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School.
Division of Gastroenterology.
J Clin Gastroenterol. 2023 Jul 1;57(6):610-616. doi: 10.1097/MCG.0000000000001727.
We sought to evaluate the association of steroids with nonalcoholic fatty liver disease (NAFLD) among patients with inflammatory bowel disease (IBD).
Patients with IBD are at increased risk of NAFLD. Steroids may have a role in the pathogenesis of NAFLD.
We searched MEDLINE (through PubMed) and Embase for studies from inception to July 2021. We included published interventional and observational studies of adults 18 years or older with ulcerative colitis or Crohn's disease. We reported odds ratios, 95% confidence intervals, and generated forest plots. A random effects model generated a summary effect estimate. Publication bias was assessed by funnel plot and Egger's test. Study quality was examined using modified Newcastle-Ottawa scale (NOS) and Agency for Healthcare Research and Quality (AHRQ).
A total of 12 observational studies with 3497 participants were included. NAFLD was identified in 1017 (29.1%) patients. The pooled odds ratio for the development of NAFLD in steroid users versus non-users was 0.87 (95% confidence interval: 0.72-1.04). There was no significant heterogeneity between studies ( I ²=0.00%, P =0.13). No publication bias was detected by funnel plot or Egger's test ( P =0.24). Findings were consistent among subgroup analyses stratified by study quality.
In this meta-analysis, steroids were not associated with NAFLD in patients with IBD. Steroids may not need to be withheld from patients with IBD for the purposes of preventing NAFLD. Additional prospective studies that systematically document steroid exposure and important confounders among patients with IBD are warranted.
我们旨在评估炎症性肠病（IBD）患者中类固醇与非酒精性脂肪性肝病（NAFLD）的相关性。
IBD 患者患 NAFLD 的风险增加。类固醇可能在 NAFLD 的发病机制中起作用。
我们在 MEDLINE（通过 PubMed）和 Embase 中搜索了从开始到 2021 年 7 月的研究。我们纳入了已发表的关于 18 岁或以上溃疡性结肠炎或克罗恩病成人的干预性和观察性研究。我们报告了比值比、95%置信区间，并生成了森林图。随机效应模型生成了汇总效应估计。通过漏斗图和 Egger 检验评估发表偏倚。使用改良的 Newcastle-Ottawa 量表（NOS）和医疗保健研究与质量局（AHRQ）评估研究质量。
共纳入了 12 项包含 3497 名参与者的观察性研究。在 1017 名（29.1%）患者中发现了 NAFLD。类固醇使用者与非使用者发生 NAFLD 的汇总比值比为 0.87（95%置信区间：0.72-1.04）。研究之间无显著异质性（ I ²=0.00%， P =0.13）。漏斗图和 Egger 检验未检测到发表偏倚（ P =0.24）。根据研究质量进行的亚组分析结果一致。
在这项荟萃分析中，类固醇与 IBD 患者的 NAFLD 无关。为了预防 NAFLD，类固醇可能不需要从 IBD 患者中停用。需要进行更多的前瞻性研究，系统地记录 IBD 患者的类固醇暴露情况和重要混杂因素。
