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Gallstone Disease Is Associated with More Severe Liver Damage in Patients with Non-Alcoholic Fatty Liver Disease 英文参考文献.docVIP

Gallstone Disease Is Associated with More Severe Liver Damage in Patients with Non-Alcoholic Fatty Liver Disease 英文参考文献.doc

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Gallstone Disease Is Associated with More Severe Liver Damage in Patients with Non-Alcoholic Fatty Liver Disease 英文参考文献

GallstoneDiseaseIsAssociatedwithMoreSevereLiver DamageinPatientswithNon-AlcoholicFattyLiver Disease AnnaLudovicaFracanzani1,LucaValenti1,MaurizioRussello2,LucaMiele3,CristinaBertelli1, AlessandroBellia2,ChiaraMasetti1,ConsueloCefalo3,AntonioGrieco3,GiulioMarchesini4, SilviaFargion1* 1Department of Internal Medicine, Centro Studi Malattie Metaboliche del Fegato, University of Milano, Maggiore Policlinico Hospital, IRCCS Ca’ Granda Foundation, Milano,Italy,2LiverUnit,ARNAS,GaribaldiHospital,Catania,Italy,3DepartmentofInternalMedicine,CattolicaUniversity,Roma,Italy,4DepartmentofInternalMedicine, AlmaMaterStudiorumUniversity,Bologna,Italy Abstract Background:Nonalcoholicfattyliverdisease(NAFLD)andgallstonedisease(GD)arebothhighlyprevalentinthegeneral population and associated with obesity and insulin resistance. We aimed to evaluate the prevalence of GD in a cross sectionalstudyofNAFLDpatientsandtodefinewhetherthepresenceofGDisassociatedwithdiabetesandpredictsmore severeliverdisease. Methodology/Principal Findings: We merged databases of four Liver Units, comprising 524 consecutive biopsy-proven NAFLD(373males)observedbetweenJanuary2003andJune2010.GDwasdiagnosedin108(20%),and313cases(60%) wereclassifiedbyliverbiopsyasnonalcoholicsteatohepatitis(NASH).TheGDsubgroupwascharacterizedbyasignificantly higher prevalence of females, prediabetes/diabetes, abdominal obesity and metabolic syndrome, older age, higher BMI, fastingglucose,HOMA-IRandlowerALT.TheprevalenceofGDprogressivelyincreasedwithadvancingfibrosisandwiththe severityofnecroinflammatoryactivity(pfortrend =0.0001and =0.01,respectively),withoutdifferencesintheseverityof steatosis.Atmultivariateanalysis GDwasassociated withfemalegender(OR 1.37,95% CI1.04–1.8), age(OR 1.027,95% CI1.003–1.05),fastingglucose(OR1.21,95%CI1.10–1.33)andNASH(OR1.40,95%CI1.06–1.89),whereasALTlevelswere associatedwithalowerGDrisk(OR0.98,95%CI0.97–0.99).Whensubjectswithcirrhosiswereexcludedfromanalysis,the associationbetweenGDandfasting

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