지방담낭염과 급성 결석성 담낭염의 위험 요인 비교 연구

Abstract

Background/Aims: Cholescystectomy rate is increasing in patients with steatocholecystitis, which is characterized by fatty infiltration of the gallbladder wall. The purpose of the study was to investigate risk factors of steatocholecystitis compared with acute acalculous cholecystitis. Methods: A retrospective study was performed on 84 patients who were shown subserosal fat accumulation by endoscopic ultrasonography (EUS) from December 2005 till June 2012. Forty four of them were diagnosed as steatocholecystitis and underwent cholecystectomy. Age and sex-matched 44 patients with acute calculous cholecystitis were selected as control. Clinical variables associated with obesity were reviewed by medical records. The thickness of total gallbladder wall and subserosal fat accumulation was measured by EUS. For understanding the relationship between steatocholecystitis and adipokines, we also examined the expression and location of the gallbladder wall tissues of steatocholecystitis patients using immunohistochemical stains for adiponectin receptor 1 and leptin. Results: Univariate analysis showed significant differences between steatocholecystitis group and acute calculous cholecystitis group in body mass index (25.50 ± 3.20 vs. 23.48 ± 2.51 kg/m2, p = 0.02), low-density lipoprotein (LDL) (103.54 ± 39.05 vs. 79.80 ± 36.70, p = 0.027), hypertension (19 vs. 7, p = 0.005) , and the thickness of gallbladder wall (6.26 ± 1.73 vs. 5.00 ± 1.43 mm, p < 0.001). Only BMI was positively correlated with steatocholecystitis by multivariate logistic regression analysis (OR (95% CI) =1.535 (1.106 – 2.131), p = 0.01). In the steatocholecystitis group, adiponectin receptor 1 and leptin expressions in epithelial cells of the gallbladder were observed in 53.6% (22/41) and 56% (23/41), respectively. Patients with both increased strength of leptin and decreased strength of adiponectin receptor 1 were 9 (9/41, 21.9%). Conclusions: BMI was the potent risk factor for steatocholecystitis compared with acute calculous cholecystitis. Obesity was also closely related to steatocholecystitis.