Onwuzo Somtochukwu, Boustany Antoine, Saleh Mustafa, Gupta Riya, Onwuzo Chidera, Mascarenhas Monteiro Jessy, Lawrence Favour, Obuekwe Chukwuemeka, Morani Zoya, Asaad Imad
Internal Medicine, Cleveland Clinic Foundation, Cleveland, USA.
Faculty of Medical Sciences, Lebanese University, Beirut, LBN.
Cureus. 2023 Mar 7;15(3):e35854. doi: 10.7759/cureus.35854. eCollection 2023 Mar.
Background and objective The global health burden of inflammatory bowel disease (IBD) stems from its increasing incidence over the years. Comprehensive studies on the topic hypothesize that IBD plays a more dominant in the development of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). In light of this, we conducted this study with the aim of assessing the prevalence and risk factors of developing NASH in patients who have had a diagnosis of ulcerative colitis (UC) and Crohn's disease (CD). Methodology A validated multicenter and research platform database of more than 360 hospitals from 26 different healthcare systems across the United States from 1999 to September 2022 was utilized for conducting this study. Patients aged 18-65 years were included. Pregnant patients and individuals diagnosed with alcohol use disorder were excluded. The risk of developing NASH was calculated using a multivariate regression analysis to account for potential confounding variables including male gender, hyperlipidemia, hypertension, type 2 diabetes mellitus (T2DM), and obesity. A two-sided p-value <0.05 was considered statistically significant, and all statistical analyses were performed using R version 4.0.2 (R Foundation for Statistical Computing, Vienna, Austria, 2008). Results A total of 79,346,259 individuals were screened in the database and 46,667,720 were selected for the final analysis based on the inclusion and exclusion criteria. Using multivariate regression analysis, the risk of developing NASH among patients with UC and CD was calculated. The odds of having NASH among patients with UC was 2.37 (95% CI: 2.17-2.60, p<0.001). Similarly, the odds of having NASH were high in patients with CD as well, at 2.79 (95% CI: 2.58-3.02, p<0.001). Conclusion Based on our findings, patients with IBD have an increased prevalence and higher odds of developing NASH after controlling for common risk factors. We believe that a complex pathophysiological relationship exists between both disease processes. Further research is required to establish appropriate screening times to enable earlier disease identification and thereby improve patient outcomes.
背景与目的 炎症性肠病（IBD）的全球健康负担源于其多年来不断上升的发病率。关于该主题的综合研究推测，IBD在非酒精性脂肪性肝病（NAFLD）和非酒精性脂肪性肝炎（NASH）的发展中起更主要作用。鉴于此，我们开展本研究旨在评估已诊断为溃疡性结肠炎（UC）和克罗恩病（CD）的患者发生NASH的患病率及危险因素。方法 利用一个经过验证的多中心研究平台数据库进行本研究，该数据库来自美国26个不同医疗系统的360多家医院，时间跨度为1999年至2022年9月。纳入年龄在18 - 65岁的患者。排除孕妇和被诊断为酒精使用障碍的个体。使用多变量回归分析计算发生NASH的风险，以考虑潜在的混杂变量，包括男性、高脂血症、高血压、2型糖尿病（T2DM）和肥胖。双侧p值<0.05被认为具有统计学意义，所有统计分析均使用R 4.0.2版本（R统计计算基金会，奥地利维也纳，2008年）进行。结果 数据库中共筛查了79346259人，根据纳入和排除标准，最终选择46667720人进行分析。通过多变量回归分析，计算了UC和CD患者发生NASH的风险。UC患者发生NASH的比值比为2.37（95%置信区间：2.17 - 2.60，p<0.001）。同样，CD患者发生NASH的比值比也很高，为2.79（95%置信区间：2.58 - 3.02，p<0.001）。结论 根据我们的研究结果，在控制常见危险因素后，IBD患者发生NASH的患病率增加且几率更高。我们认为这两种疾病过程之间存在复杂的病理生理关系。需要进一步研究以确定合适的筛查时间，以便更早地识别疾病，从而改善患者预后。
