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研究生:蕭舜文
研究生(外文):Shun-Wen Hsiao
論文名稱:代謝相關性脂肪肝在發炎性腸道疾病患者的盛行率及危險因子
論文名稱(外文):The prevalence and risk factors of metabolic dysfunction associated fatty liver disease in inflammatory bowel disease
指導教授:黃建寧黃建寧引用關係林志立
指導教授(外文):Chien-Ning HuangChih-Li Lin
口試委員:顏旭亨
口試日期:2023-06-08
學位類別:碩士
校院名稱:中山醫學大學
系所名稱:醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2023
畢業學年度:111
語文別:中文
論文頁數:31
中文關鍵詞:發炎性腸道疾病代謝相關性脂肪肝肝臟纖維化
外文關鍵詞:Inflammatory bowel diseasemetabolic dysfunction associated fatty liver diseasesliver fibrosis
DOI:10.6834/csmu202300125
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引言:發炎性腸道疾病包含克隆氏症及潰瘍性結腸炎為一種腸道慢性發炎的疾病,其盛行率在全球包含台灣都發現有逐漸增加的趨勢。同樣,脂肪肝的盛行率也逐年增加。發炎性腸道疾病患者合併脂肪肝的盛行率隨著不同區域而有不同,此外相關的風險因子仍未確定。本篇研究使用肝臟纖維化掃描儀評估發炎性腸道疾病患者合併脂肪肝的盛行率,及肝臟纖維化的盛行率並從中分析風險因子。
研究方式:我們回溯性的分析中部某一醫學中心從2019年1月至2023年04月診斷為發炎性腸道疾病的患者。並以肝臟纖維化掃描儀評估患者脂肪肝的程度及纖維化的程度。我們使用代謝相關性脂肪肝的定義診斷脂肪肝。
研究結果:總共有120名發炎性腸道疾病的患者納入分析,克隆氏症患者有45名而且潰瘍性結腸炎患者有75名。男性佔多數。克隆氏症診斷年齡較潰瘍性結腸炎低分別是37歲與45歲(p=0.089)。相較於潰瘍性結腸炎患者,克隆氏症有比較高的腸切除病史(46.7% vs. 2.7%, p<0.001)。代謝相關性脂肪肝在發炎性腸道疾病中的盛行率為29.2%。合併有代謝相關性脂肪肝的患者有比較短的病程(2.8 years vs. 5.3 years, p=0.017),比較高的丙胺酸轉胺酶(ALT)(24 U/L vs.17 U/L, p=0.003) ,比較低的腎絲球過濾率(91.37 mL/min/1.73m² vs.103.92 mL/min/1.73m², p=0.004),和比較高的丙麩胺醯氨轉酸酶(γ-GT) (24 mg/dL vs. 13 mg/dL, p<0.001)。在多變量的分析中,合併代謝相關性脂肪肝有比較高的血紅素(aOR: 1.91, 95% CI 1.17-3.13, p=0.010) ,比較高的丙麩胺醯氨轉酸酶(γ-GT)(aOR: 1.11, 95% CI 1.02-1.21, P=0.013),和顯著肝臟纖維化(aOR: 31.25, 95% CI:1.2-815.55, p=0.039)。
結論:代謝相關性脂肪肝在發炎性腸道疾病患者中的盛行率為29.2%,合併代謝相關性脂肪肝有比較高的血紅素,比較高的丙麩胺醯氨轉酸酶(γ-GT),和顯著肝臟纖維化。
Introduction: Inflammatory bowel diseases (IBD), included ulcerative colitis (UC) and Crohn’s disease (CD), are chronic inflammatory disorders affecting gastrointestinal tract. The prevalence of IBD was increased globally included Taiwan. The similar increased prevalence was also noted in fatty liver disease. The prevalence of IBD with fatty liver disease was differed in different region and the risk factors still remain uncertain. This study aims to analysis the prevalence and risk factors of fatty liver and liver fibrosis in IBD patients in our cohort by transient elastography and identified factors associated with steatosis and fibrosis.
Methods: We retrospectively analyzed patients with diagnosis of IBD from January 2019 to April 2023 at our institution. Patients received TE encompass liver stiffness measurements and controlled attenuation parameter for evaluation liver fibrosis and steatosis were enrolled. We use definition of metabolic dysfunction associated fatty liver disease(MAFLD) for diagnosis.
Result: A total of 120 patients with IBD were enrolled and CD were 45 and UC were 75. Male was more predominant in IBD. The diagnosed age was younger in CD than in UC (37 years vs. 45 years, p=0.089). CD patients tend to previous bowel resection history (46.7% vs. 2.7%, p<0.001). MAFLD prevalence in IBD was 29.2%. MAFLD patients had shorter disease duration (2.8 years vs. 5.3 years, p=0.017), higher ALT level (24 U/L vs.17 U/L, p=0.003), lower estimate of glomerular filtration rate (eGFR) (91.37 mL/min/1.73m² vs.103.92 mL/min/1.73m², p=0.004), and higher γ-GT (24 mg/dL vs. 13 mg/dL, p<0.001) compared with non-MAFLD patients. In multivariate analysis, MAFLD was associated with high Hb (aOR: 1.91, 95% CI 1.17-3.13, p=0.010), elevated γ-GT (aOR: 1.11, 95% CI 1.02-1.21, P=0.013), and significant liver fibrosis (aOR: 31.25, 95% CI:1.2-815.55, p=0.039).
Conclusions: The prevalence of MALFD in IBD was 29.2%. MAFLD was associated with high Hb, elevated γ-GT, and significant liver fibrosis.
謝誌 I
中文摘要 II
英文摘要 III
英文縮寫全名與中英文對照表 IV
目錄 VI
表目錄 VIII
圖目錄 IX
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第二章 研究內容與研究方式 4
第一節 資料來源與研究對象 4
第二節 代謝相關性脂肪肝的定義 7
第三節 統計分析 8
第三章 研究結果 9
第一節 比較潰瘍性結腸炎與克隆氏症兩者的差異 9
第二節 有無代謝相關性脂肪肝患者的比較 11
第三節 代謝相關性脂肪肝的風險因子 13
第四節 代謝相關性脂肪肝合併顯著纖維化的比較 14
第四章 討論 15
第五章 研究限制 18
第六章 結論與建議 19
第七章 參考文獻 20

表目錄
表格一 患者的基礎特徵之一 (基礎特徵及病史) 23
表格二 患者的基礎特徵之二(血液學檢查) 24
表格三 患者的基礎特徵之三(肝臟脂肪程度及纖維化程度) 25
表格四 有無代謝相關性脂肪肝患者的比較(基礎特徵及病史) 26
表格五 有無代謝相關性脂肪肝患者的比較之二(血液學檢查) 27
表格六 有無代謝相關性脂肪肝患者的比較之三(肝臟脂肪程度及纖維化程度) 28
表格七 與代謝相關性脂肪肝有關因子的多變量分析 29
表格八 代謝相關性脂肪肝合併纖維化的比較 30

圖目錄
圖一 研究流程圖 31
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