當非酒精性脂肪性肝病與IBD共存
翻譯及述評丨上海國際醫學中心 夏璐
來源|醫學界消化頻道(CCCF—IBD學習驛站出品)
Co-existence of non-alcoholic fatty liver disease and inflammatory bowel disease: a review article
Che-yung Chao, Robert Battat, Alex Al Khoury, Sophie Restellini, Giada Sebastiani, Talat Bessissow
摘要
目前已經有很多臨床資料提示非酒精性脂肪性肝病(NAFLD)與炎症性腸病(IBD)共同發生的情況,這兩者本身均為發病率逐漸升高、可能發生各種併發症且會造成很大醫療負擔的疾病。
Abstract
Emerging data have highlighted the co-existence of nonalcoholic fatty liver disease (NAFLD) and inflammatory bowel disease; both of which are increasingly prevalent disorders with significant complications and impact on future health burden. Cross-section observational studies have shown widely variable prevalence rates of co-existing disease, largely due to differences in disease definition and diagnostic tools utilised in the studies. Age, obesity, insulin resistance and other metabolic conditions are common risks factors in observational studies. However, other studies have also suggested a more dominant role of inflammatory bowel disease related factors such as disease activity, duration, steroid use and prior surgical intervention, in the development of NAFLD. This suggests a potentially more complex pathogenesis and relationship between the two diseases which may be contributed by factors including altered intestinal permeability, gut dysbiosis and chronic inflammatory response. Commonly used immunomodulation agents pose potential hepatic toxicity, however no definitive evidence exist linking them to the development of hepatic steatosis, nor are there any data on the impact of therapy and prognosis in patient with co-existent diseases. Further studies are required to assess the impact and establish appropriate screening and management strategies in order to allow early identification, intervention and improve patient outcomes.
IBD合併NAFLD的可能相關因素
述評
非酒精性脂肪性肝病(NAFLD)是指除外長期大量飲酒和其他損傷肝臟因素引起的以肝臟脂肪沉積為主要表現的臨床綜合征,
本文從IBD發生NAFLD的流行病學資料、發病機制和臨床意義三個方面進行闡述。NAFLD在普通人群中的發病與糖尿病、脂代謝異常及肥胖症相關,
肝活檢是診斷NAFLD並對其進行纖維化分級的金標準,但因其為侵入性且較昂貴不適用於疾病篩查,非侵入性的方法包括血清標誌物、超聲檢查、CT和MRI等影像學檢查。針對NAFLD的治療重在飲食和生活方式的調整,包括建議減重>7%等,而對IBD合併NAFLD的患者這一方法並不完全合適,因IBD患者可能本身就存在各種營養缺陷,一些抗肝纖維化藥物、匹格列酮、Vit E、奧貝膽酸等均在臨床驗證中,因此建議IBD合併NAFLD的患者,需根據具體營養情況、參照NAFLD的治療指南進行個體化干預。
雖然目前對於IBD是否會促進NAFLD的發生發展仍無定論,但兩者合併存在無疑會造成更為複雜的診治難題,也提示當發現IBD患者出現肝功能異常的時候,臨床醫生需要考慮發生NAFLD的可能性並進行相應檢查,其中無創性的檢查如暫態彈性成像(TE)、肝纖維化檢測或應用NAFLD肝纖維化評分系統等是較好的選擇。對於這樣腸肝病變合併發生的情況,多學科合作以及長期的隨訪尤為重要。
審核:范建高教授
但因其為侵入性且較昂貴不適用於疾病篩查,非侵入性的方法包括血清標誌物、超聲檢查、CT和MRI等影像學檢查。針對NAFLD的治療重在飲食和生活方式的調整,包括建議減重>7%等,而對IBD合併NAFLD的患者這一方法並不完全合適,因IBD患者可能本身就存在各種營養缺陷,一些抗肝纖維化藥物、匹格列酮、Vit E、奧貝膽酸等均在臨床驗證中,因此建議IBD合併NAFLD的患者,需根據具體營養情況、參照NAFLD的治療指南進行個體化干預。雖然目前對於IBD是否會促進NAFLD的發生發展仍無定論,但兩者合併存在無疑會造成更為複雜的診治難題,也提示當發現IBD患者出現肝功能異常的時候,臨床醫生需要考慮發生NAFLD的可能性並進行相應檢查,其中無創性的檢查如暫態彈性成像(TE)、肝纖維化檢測或應用NAFLD肝纖維化評分系統等是較好的選擇。對於這樣腸肝病變合併發生的情況,多學科合作以及長期的隨訪尤為重要。
審核:范建高教授