Chen Jun, Liu Zheng-Tao, Lyu Jing-Ting, Jiang Guo-Ping
Zhejiang Chinese Medical University, Hangzhou 310053, China.
Department of Hepatobiliary Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou 310022, China; Zhejiang Shuren University, Hangzhou 310015, China.
Hepatobiliary Pancreat Dis Int. 2024 Dec;23(6):604-612. doi: 10.1016/j.hbpd.2024.08.001. Epub 2024 Aug 5.
Gallstone disease (GSD), nonalcoholic fatty liver disease (NAFLD), metabolic dysfunction-associated fatty liver disease (MAFLD), and metabolic syndrome (MetS) are common medical disorders worldwide. This study aimed to ascertain how NAFLD, MAFLD, MetS, and other factors affect the development of GSD, and how the GSD-associated factors influence patient recovery after laparoscopic cholecystectomy (LC).
We included 200 patients who were diagnosed with GSD and underwent LC between January 2017 and February 2022. A total of 200 subjects without GSD and "non-calculous causes" during the same period were also included as controls. We compared the metabolic disorder differences between GSD patients and controls. Furthermore, we sub-grouped patients based on the comorbidities of preoperative NAFLD, MAFLD, and MetS, and compared the impacts of these comorbidities on short-term post-LC functional recovery of the patients.
The prevalence of NAFLD and MetS were higher in GSD patients (P < 0.05). Based on multivariate logistic regression analysis, hyperglycemia [odds ratio (OR) = 2.2, 95% confidence interval (CI): 1.4-3.4, P = 0.001] and low high-density lipoprotein cholesterol (HDL-C) level (OR = 1.8, 95% CI: 1.1-3.1, P = 0.048) were linked to GSD. NAFLD and MetS linked to liver enzymes after LC (P < 0.05). MetS also linked to the levels of inflammatory indicators after LC (P < 0.05). The obesity, hyperlipidemia, low HDL-C level, and hyperglycemia linked to liver enzymes after LC (P < 0.05). Hyperlipidemia, low HDL-C level, and hypertension linked to inflammation after LC (P < 0.05).
The prevalence of GSD may be linked to NAFLD and MetS. Hyperglycemia and low HDL-C level were independent risk factors of GSD.
胆结石病（GSD）、非酒精性脂肪性肝病（NAFLD）、代谢功能障碍相关脂肪性肝病（MAFLD）和代谢综合征（MetS）是全球常见的医学病症。本研究旨在确定NAFLD、MAFLD、MetS和其他因素如何影响GSD的发展，以及GSD相关因素如何影响腹腔镜胆囊切除术（LC）后患者的恢复。
我们纳入了2017年1月至2022年2月期间被诊断为GSD并接受LC的200例患者。同期还纳入了200例无GSD且无“非结石性病因”的受试者作为对照。我们比较了GSD患者和对照之间的代谢紊乱差异。此外，我们根据术前NAFLD、MAFLD和MetS的合并症对患者进行亚组划分，并比较这些合并症对患者LC术后短期功能恢复的影响。
GSD患者中NAFLD和MetS的患病率较高（P < 0.05）。基于多因素逻辑回归分析，高血糖[比值比（OR）= 2.2，95%置信区间（CI）：1.4 - 3.4，P = 0.001]和低高密度脂蛋白胆固醇（HDL-C）水平（OR = 1.8，95% CI：1.1 - 3.1，P = 0.048）与GSD相关。NAFLD和MetS与LC后的肝酶相关（P < 0.05）。MetS也与LC后的炎症指标水平相关（P < 0.05）。肥胖、高脂血症、低HDL-C水平和高血糖与LC后的肝酶相关（P < 0.05）。高脂血症、低HDL-C水平和高血压与LC后的炎症相关（P < 0.05）。
GSD的患病率可能与NAFLD和MetS相关。高血糖和低HDL-C水平是GSD的独立危险因素。
