代谢相关脂肪性肝病对炎症性肠病疾病特征及活动性的影响：一项回顾性队列研究

Impact of Metabolic Dysfunction-Associated Fatty Liver Disease on the Characteristics and Activity of Inflammatory Bowel Disease: A Retrospective Cohort Study

摘要: 目的：近年来，炎症性肠病(Inflammatory Bowel Disease, IBD)与代谢相关脂肪性肝病(Metabolic Dysfunction-Associated Steatotic Liver Disease, MASLD)的发病率均呈上升趋势。本研究旨在探讨MASLD对IBD患者疾病特征及活动性的影响。方法：回顾性收集2023年1月至2024年4月于青岛大学附属医院就诊的IBD患者，经纳排标准筛选后共676例纳入研究。根据是否合并MASLD分为暴露组(IBD合并MASLD，86例)和对照组(单纯IBD，590例)。收集基线及12个月随访的临床资料，并采用二元Logistic回归分析调整混杂因素。结果：基线时，暴露组患者年龄更大，吸烟和饮酒比例更高，疾病活动性生物标志物水平显著高于对照组(P < 0.05)。随访12个月后，暴露组临床缓解率和黏膜愈合率低于对照组，而生物标志物水平及复发再入院率高于对照组。经调整年龄、吸烟、饮酒、IBD病程及亚型后，暴露组黏膜愈合率仍显著低于对照组(22.09% vs. 39.83%, OR = 0.422, 95%CI: 0.245~0.729, P = 0.002)，C反应蛋白水平升高率亦显著高于对照组(25.58% vs. 15.42%, OR = 1.813, 95%CI: 1.049~3.133, P = 0.033)。结论：MASLD与IBD疾病活动性升高相关。临床应重视IBD患者中MASLD的识别与干预，以改善患者预后。

Abstract: Objective: In recent years, the incidence of both inflammatory bowel disease (IBD) and metabolic dysfunction-associated steatotic liver disease (MASLD) has been increasing. This study aims to investigate the impact of MASLD on the disease characteristics and activity in patients with IBD. Methods: A retrospective collection of patients with IBD treated at the Affiliated Hospital of Qingdao University from January 2023 to April 2024 was conducted. After screening according to inclusion and exclusion criteria, a total of 676 patients were included in the study. Based on the presence or absence of MASLD, patients were divided into an exposure group (IBD with MASLD, 86 cases) and a control group (IBD alone, 590 cases). Clinical data were collected at baseline and after 12 months of follow-up. Binary logistic regression analysis was used to adjust for confounding factors. Results: At baseline, patients in the exposure group were older, had higher proportions of smoking and alcohol consumption, and exhibited significantly higher levels of disease activity biomarkers compared to the control group (P < 0.05). After 12 months of follow-up, the exposure group showed lower rates of clinical remission and mucosal healing, while biomarker levels and rates of recurrence and readmission were higher than those in the control group. After adjusting for age, smoking, alcohol consumption, IBD duration, and subtype, the mucosal healing rate in the exposure group remained significantly lower than that in the control group (22.09% vs. 39.83%, OR = 0.422, 95%CI: 0.245~0.729, P = 0.002), and the rate of elevated C-reactive protein levels was significantly higher in the exposure group (25.58% vs. 15.42%, OR = 1.813, 95%CI: 1.049~3.133, P = 0.033). Conclusions: MASLD is associated with increased disease activity in IBD. Emphasis should be placed on the identification and intervention of MASLD in patients with IBD to improve patient prognosis.