Prevalencia de la esteatosis hepática metabólica (EHMet) en pacientes con litiasis vesicular. Estudio de una cohorte de casos en el sur-sureste de México

Abstract

Resumen: Introducción: La esteatosis hepática metabólica (EHMet) y la colelitiasis son entidades que comparten factores de riesgo similares. Numerosas publicaciones confirman su elevada frecuencia, sin embargo, pocos estudios han considerado su prevalencia y posible asociación. Objetivo: Determinar la prevalencia de EHMet en pacientes con colelitiasis y la utilidad de la biopsia hepática para el diagnóstico de la enfermedad. Material y métodos: Estudio prospectivo de pacientes tratados mediante colecistectomía laparoscópica a los cuales se realizó biopsia hepática. Variables analizadas: Características antropométricas, perfil bioquímico, ultrasonido convencional, factores de riesgo y estudio histopatológico de biopsia hepática. Análisis estadístico: Se emplearon estadísticas descriptivas para variables cuantitativas y t de Student y análisis multivariado mediante regresión logística binaria para variables continuas, empleando el programa IBM-SPSS, 25.0 (Windows). Resultados: Ciento treinta y seis pacientes, clasificados en 2 grupos: hígado normal 40 (29.41%) y EHMet 96 (70.59%) de ellos 71 (52.21%) correspondieron a esteatosis hepática, 21 (15.44%) a esteatohepatitis y 4 (2.94%) a cirrosis. En 39 casos (28.68%) se encontró inflamación perisinusoidal y en 10 (7.35%) fibrosis. Los factores de riesgo para ambos grupos fueron edad, diabetes, hipertensión arterial y obesidad; los niveles de glucosa, triglicéridos y aminotransferasas fueron significativamente superiores en EHMet y el ultrasonido convencional fue un estudio de moderada concordancia para su detección. Discusión y conclusiones: Los resultados confirman la elevada frecuencia de EHMet asociada a colelitiasis por lo cual se justifica realizar la biopsia hepática durante la colecistectomía para establecer su diagnóstico. Abstract: Introduction: Metabolic (dysfunction) associated fatty liver disease (MAFLD) and gallstone disease are entities that share similar risk factors. Numerous publications confirm their elevated frequency, but few studies have considered their prevalence and possible association. Aims: To determine the prevalence of MAFLD in patients with gallstone disease and the usefulness of liver biopsy for diagnosing the liver disease. Material and methods: A prospective study was conducted on patients that underwent laparoscopic cholecystectomy, in whom liver biopsy was performed. Variables analyzed: Anthropometric characteristics, biochemical profile, conventional ultrasound, risk factors, and histopathologic study of the liver biopsy. Statistical analysis: Descriptive statistics were carried out for the quantitative variables and the Student's t test and multivariate analysis through binary logistic regression were employed for the continuous variables, utilizing IBM-SPSS, 25.0 (Windows) software. Results: A total of 136 patients were classified into 2 groups: 40 (29.41%) with normal liver and 96 (70.59%) with MAFLD. Of the 136 patients, 71 patients (52.21%) corresponded to hepatic steatosis, 21 (15.44%) to steatohepatitis, and 4 (2.94%) to cirrhosis. Perisinusoidal inflammation was found in 39 cases (28.68%) and fibrosis was found in 10 (7.35%). The risk factors for both groups were age, diabetes, high blood pressure, and obesity. Glucose, triglyceride, and aminotransferase levels were significantly higher in the MAFLD group and conventional ultrasound demonstrated moderate concordance for its detection. Discussion and conclusions: The results confirmed the elevated frequency of MAFLD associated with gallstone disease, justifying liver biopsy during cholecystectomy for diagnosing MAFLD.

Keywords

• Metabolic (dysfunction) associated fatty liver disease
• Gallstones
• Metabolic syndrome