Huang Hangkai, Liu Zhening, Ruan Jiaqi, Fang Zejun, Xu Chengfu
Department of Gastroenterology, Zhejiang Provincial Clinical Research Centre for Digestive Diseases, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
Sanmenwan Branch, The First Affiliated Hospital, Zhejiang University School of Medicine, Taizhou, China.
Reprod Biol Endocrinol. 2025 Apr 9;23(1):55. doi: 10.1186/s12958-025-01391-2.
To investigate whether endometriosis is associated with the risk of incident nonalcoholic fatty liver disease (NAFLD).
Data were retrieved from Nurses' Health Study II with participants followed up from 1995 to 2017. A total of 61,649 participants were included in this prospective cohort study. The exposure of this study was laparoscopically confirmed endometriosis. We performed Cox proportional hazard regression analyses to estimate the hazard ratio (HR) and 95% confidence interval (95% CI) of the association between endometriosis and NAFLD.
A total of 4,774 incident NAFLD cases were recorded during a 1,313,067 person-years of follow-up. In the multivariable adjusted model, laparoscopically confirmed endometriosis was positively associated with the risk of NAFLD (HR: 1.17, 95% CI: 1.07 - 1.29). The results of the mediation analyses revealed that the association was partly attributable to hysterectomy/oophorectomy (31.6% mediated, 95% CI: 18.8-47.9%), hypercholesterolemia, hypertension and infertility. Further analysis revealed that the interaction effect of age was significant for the association between endometriosis and NAFLD (P = 0.01).
Laparoscopically confirmed endometriosis was positively associated with the risk of incident NAFLD. Awareness of the potential NAFLD risk should be raised for clinicians and patients during the regular follow-up of endometriosis.
探讨子宫内膜异位症是否与非酒精性脂肪性肝病（NAFLD）的发病风险相关。
数据来自护士健康研究II，参与者于1995年至2017年进行随访。本前瞻性队列研究共纳入61649名参与者。本研究的暴露因素为经腹腔镜确认的子宫内膜异位症。我们进行了Cox比例风险回归分析，以估计子宫内膜异位症与NAFLD之间关联的风险比（HR）和95%置信区间（95%CI）。
在1313067人年的随访期间，共记录了4774例新发NAFLD病例。在多变量调整模型中，经腹腔镜确认的子宫内膜异位症与NAFLD风险呈正相关（HR：1.17，95%CI：1.07 - 1.29）。中介分析结果显示，这种关联部分归因于子宫切除术/卵巢切除术（中介效应为31.6%，95%CI：18.8 - 47.9%）、高胆固醇血症、高血压和不孕症。进一步分析显示，年龄的交互作用对子宫内膜异位症与NAFLD之间的关联具有显著意义（P = 0.01）。
经腹腔镜确认的子宫内膜异位症与新发NAFLD风险呈正相关。在子宫内膜异位症的定期随访中，临床医生和患者应提高对潜在NAFLD风险的认识。
