Department of Internal Medicine, Cleveland Clinic, 9500 Euclid Avenue, A3-208, Cleveland, OH, 44195, USA.
Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
Dig Dis Sci. 2023 Mar;68(3):1006-1015. doi: 10.1007/s10620-022-07562-0. Epub 2022 Jun 22.
Chronic inflammation in IBD is postulated to drive NAFLD progression from steatosis to fibrosis.
To study the histopathological spectrum of NAFLD in Crohn disease (CD) and Ulcerative colitis (UC).
Patients with biopsy proven NAFLD at a quaternary center from 2008 to 2018 were included in this retrospective analysis. Inflammatory bowel disease (IBD) diagnosed either clinically and/or endoscopically at the time of liver biopsy. Multivariable regression and propensity score (PS) weighted analysis were conducted. Statistical analysis were performed using SAS statistical software.
Among 1009 patients with NAFLD a diagnosis of IBD was identified in 50 cases (34 CD and 16 UC). On multivariable analysis; CD was independently associated with significantly higher odds of advanced fibrosis (AF) on liver biopsy (adjusted OR = 4.09, 95% CI = 1.40-11.94) compared to NAFLD patients without IBD. Similar results were obtained with both the overlap PS weighted model (OR = 3.17, 95% CI = 1.55-6.49) and the PS matched model (OR = 3.49, 95% CI = 1.50-8.13).
In a large cohort of patients with histologically well characterized NAFLD, AF was more common in CD patients than NAFLD patients without IBD. These findings must be confirmed in a larger cohort, but suggest CD patients with NAFLD could be at greater risk for liver fibrosis.
炎症性肠病（IBD）中的慢性炎症被认为是导致非酒精性脂肪性肝病（NAFLD）从脂肪变性进展为纤维化的原因。
研究克罗恩病（CD）和溃疡性结肠炎（UC）中 NAFLD 的组织病理学谱。
本回顾性分析纳入了 2008 年至 2018 年在一家四级中心通过活检证实为 NAFLD 的患者。在进行肝活检时，IBD 无论是临床诊断还是内镜诊断。进行了多变量回归和倾向评分（PS）加权分析。统计分析使用 SAS 统计软件进行。
在 1009 例 NAFLD 患者中，50 例（34 例 CD 和 16 例 UC）诊断为 IBD。多变量分析显示，与无 IBD 的 NAFLD 患者相比，CD 患者肝活检时发生晚期纤维化（AF）的可能性显著更高（调整后的 OR=4.09，95%CI=1.40-11.94）。重叠 PS 加权模型（OR=3.17，95%CI=1.55-6.49）和 PS 匹配模型（OR=3.49，95%CI=1.50-8.13）均得到了类似的结果。
在一组组织学特征明确的 NAFLD 患者中，AF 在 CD 患者中比无 IBD 的 NAFLD 患者更为常见。这些发现必须在更大的队列中得到证实，但提示 CD 合并 NAFLD 的患者发生肝纤维化的风险可能更高。
