脂肪肝与小肠黏膜病变的相关性

Association between fatty liver and small intestinal mucosal lesions

目的:研究脂肪肝与小肠黏膜病变的相关性.方法:选取广东药学院附属第一医院2011-08/2015-08曾行胶囊内镜且无癌症、小肠结核、克罗恩病、溃疡性结肠炎等肠道原发疾病及服用非甾体类药物的患者分为脂肪肝组和无肝病组(对照组),收集相关临床资料和小肠黏膜病变资料,将两组患者的发病率、发病类型、病灶分布进行分析比较.结果:纳入研究350例脂肪肝组60例,无肝病组290例,脂肪肝组小肠黏膜病变的发病率及小肠黏膜病变的Lewis评分均显著高于对照组(75.0%vs 33.8%,P<0.001;121.00分±178.51分vs 61.08分±144.10分,P=0.005)脂肪肝患者小肠上、中、下三分之一肠段绒毛水肿的发生率为(7.1%、15.7%、4.3%P<0.001).脂肪肝患者上、中、下三分之一肠段溃疡的发生率为(2.0%、2.6%、3.4%,P=0.498).肝脏无创NAFLD-FS评分与小肠黏膜病变评分呈正相关(r=0.108,P=0.043)胰岛素抵抗指数与小肠黏膜病变评分呈正相关(r=0.162,P=0.034).结论:脂肪肝可引起小肠黏膜病变,甘油三酯有可能是脂肪肝引起小肠黏膜病变的重要影响因素.脂肪肝患者小肠黏膜病变好发于上、中1/3,肝脏损害程度与小肠黏膜病变程度存在相关性.

AIM： To assess the association between fatty liver and small intestinal mucosal lesions.METHODS： After obtaining approval from the ethical review committee of the First Affiliated Hospital of Guangdong Pharmace utical University, from August 2011 to August 2015, patients who were excluded as having cancer or primary intestinal disease and NSAID takers were divided into a fatty liver group（case group） and a group without liver disease（control group）. Intestinal lesions were detected by capsule endoscopy, and the correlation of capsule endoscopy scoring index with fatty liver index was analyzed. RESULTS： Of 350 individuals, 60 diagnosed with fatty liver by CT or B ultrasound were included in the case group, and 290 without liver diseases were included in the control group. The incidence of small bowel mucosal lesions and the Lewis score in the case group were significantly higher than those in the control group（75.0% vs 33.8%, P 〈 0.001; 121.00±178.51 vs 61.08 ± 144.10, P = 0.005）. In fatty liver patients, the incidence rates of small intestinal edema in the upper, middle and lower third were 7.1%, 15.7%, and 4.3%（P〈0.001）, respectively, and the incidence rates of small intestinal ulcers were 2.0%, 2.6%, and 3.4%（P=0.498）, respectively. Liver noninvasive NAFLD-FS score was positively correlated with the small intestinal mucosa damage score（r=0.108, P=0.043）. Insulin resistance index was positively correlated with small intestinal damage score（r=0.162,P=0.034）.CONCLUSION： Fatty liver disease may be related to the small intestine lesions, and triglycerides may be an important factor. Most lesions are located in the proximal or middle small bowel.