Martínez-Domínguez Samuel J, García-Mateo Sandra, Laredo Viviana, Gargallo-Puyuelo Carla J, Gallego Llera Beatriz, López de la Cruz Julia, Gomollón Fernando
Department of Gastroenterology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain.
Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain.
Cancers (Basel). 2023 Jun 27;15(13):3367. doi: 10.3390/cancers15133367.
The aim of the systematic review is to assess the prevalence and risk factors of liver fibrosis in patients with Inflammatory Bowel Disease (IBD) and Non-Alcoholic Fatty Liver Disease (NAFLD) and to discuss the role of liver fibrosis in the progression to hepatocellular carcinoma (HCC). We performed a structured search in PubMed, Web of Science, Embase, and Scopus up to 3 March 2023 to identify observational studies reporting liver fibrosis in patients with NAFLD and IBD. Quality of studies was assessed using the Newcastle-Ottawa Scale (NOS) score. A total of 23 studies met our inclusion criteria, including 629,781 patients. A total of 10 cross-sectional, 3 case-control, and 10 cohort studies were included. Fourteen studies had a NOS score ≥ 7 points. NAFLD was diagnosed in 2162/6332 (34.1%) IBD participants. However, NAFLD diagnosis was established in 924/2962 (31.2%) healthy individuals without IBD. Advanced liver fibrosis was found in 116 (11.6%) of 992 IBD patients with NAFLD. Most studies found an association between NAFLD and classic cardiovascular risk factors such as older age, male sex, higher BMI, diabetes, hypertension and dyslipidemia. In addition, metabolic syndrome features were also associated with an increased risk of significant and advanced liver fibrosis. Although no strong association between NAFLD and IBD therapy was reported, some studies associated NAFLD with IBD diagnosis, Crohn's Disease, a complicated course of IBD, disease activity, and IBD duration. Advanced liver fibrosis was also associated with Crohn's disease in several studies. In conclusion, NAFLD and advanced liver fibrosis are prevalent and clinically relevant extraintestinal manifestations, so its diagnosis and potential progression to HCC should be carefully considered in daily clinical practice.
本系统评价的目的是评估炎症性肠病（IBD）和非酒精性脂肪性肝病（NAFLD）患者肝纤维化的患病率及危险因素，并探讨肝纤维化在肝细胞癌（HCC）进展中的作用。我们在截至2023年3月3日的PubMed、Web of Science、Embase和Scopus数据库中进行了结构化检索，以识别报告NAFLD和IBD患者肝纤维化情况的观察性研究。使用纽卡斯尔-渥太华量表（NOS）评分评估研究质量。共有23项研究符合我们的纳入标准，包括629,781例患者。其中包括10项横断面研究、3项病例对照研究和10项队列研究。14项研究的NOS评分≥7分。在6332例IBD参与者中，2162例（34.1%）被诊断为NAFLD。然而，在2962例无IBD的健康个体中，924例（31.2%）被诊断为NAFLD。在992例患有NAFLD的IBD患者中，116例（11.6%）发现有晚期肝纤维化。大多数研究发现NAFLD与年龄较大、男性、较高的体重指数、糖尿病、高血压和血脂异常等经典心血管危险因素之间存在关联。此外，代谢综合征特征也与显著和晚期肝纤维化风险增加相关。尽管未报告NAFLD与IBD治疗之间存在强关联，但一些研究将NAFLD与IBD诊断、克罗恩病、IBD的复杂病程、疾病活动度和IBD病程相关联。在几项研究中，晚期肝纤维化也与克罗恩病相关。总之，NAFLD和晚期肝纤维化是常见且具有临床相关性的肠外表现，因此在日常临床实践中应仔细考虑其诊断以及向HCC进展的可能性。
