The Prevalence And Risk Factors Of Simple Hepatic Cysts

?Background and Objective?Simple hepatic cyst(hereinafter referred to as hepatic cyst)is one of the most common benign space-occupying lesions of the liver,and is also one of the most common chronic liver diseases in the gastroenterology clinic or liver disease clinic.Most patients with hepatic cyst have no obvious symptoms,however,with the growth of age,the size of the cyst may gradually increase,and patients may suffer from abdominal distension and abdominal pain.Some patients may even suffer from symptoms caused by severe oppression of the surrounding tissues and organs by cysts,such as jaundice and Budd-Chiari syndrome.Moreover,some may suffer serious complications caused by cyst itself,such as intracystic infection,hemorrhage and even rupture.Unfortunately,some patients may suffer from recurrent attacks of these complications,which seriously affect the patients' quality.As a common chronic liver disease,understanding the epidemiological characteristics of simple hepatic cyst,including prevalence,sex and age distribution as well as its risk factors is helpful for clinicians to better evaluate and treat patients.Because most of the patients have no symptoms,hepatic cyst is often found incidentally by regular abdominal imaging examinations.Therefore,previous studies aiming to investigate the prevalence of hepatic cysts were based on population who come to the hospital for imaging examination.The reported prevalence ranged from 2.5% to 18%,with only one study from Taiwan including community-based population.The other studies were based on hospital population,which could not represent authentic prevalence of the disease.Also because most of the reported prevalence is based on hospital population,which could not collect all the demographic characteristics and clinical data of the patients and unaffected controls,it is difficult to analyze the associated risk factors for simple hepatic cysts.Furthermore,the community population-based survey from Taiwan also did not analyze risk factors.Therefore,the associated risk factors for hepatic cysts have not been reported.This study aims to determine the prevalence of simple hepatic cyst in the general population by performing an epidemiological survey of community-based population,and to determine the prevalence of hepatic cysts in a hospital-based population inChangzheng hospital;to compare the clinical characteristics of patients with hepatic cyst and those without in the community-based population,and to analyze the possible risk factors of hepatic cysts.These findings will provide evidence for clinicians to evaluate,monitor and treat patients with refractory hepatic cysts.?Methods?1.Epidemiological investigation of simple hepatic cyst in community population in Shanghai(1)Relying on “the epidemiological investigation project of Shanghai adult autoimmune thyroid disease and chronic liver disease in 2017” which was performed by department of gastroenterology and department of endocrinology of Changzheng hospital,a cross-sectional survey was conducted among residents based on the population of 18 districts and 242 community health service centers in Shanghai.(2)Three-stage stratified sampling strategy was adopted to obtain representative samples of urban population.(3)The enrolled subjects of the study were reviewed by well-trained medical personnel.All the subjects filled in a uniform questionnaire,were measured for human body data,underwent abdominal ultrasound examination,and were collected blood samples at various community health service centers.(4)According to the abdominal ultrasound results,the number of patients with simple liver cyst were calculated,and the gender and age distribution,the ultrasonic manifestations of hepatic cyst were analyzed.2.Investigation on the prevalence of simple hepatic cyst in Shanghai Changzheng hospital(1)Data of patients who received abdominal ultrasound examination in 2018 in Changzheng hospital were collected.(2)The number,sex and age of patients with simple liver cyst were counted.(3)Make comparison between the data of community-based population and hospital-based population.3.Risk factors of simple hepatic cyst were analyzed in community-based population(1)Analyze the differences in demographic characteristics,clinical characteristics and blood test results between patients with hepatic cyst in the community populationand the control group without hepatic cyst,and search for clues of risk factors.(2)Univariate logistics regression was used to analyze the possible risk factors in patients with simple hepatic cyst.(3)Factors with statistical differences in univariate analysis were included in multivariate analysis to identify independent risk factors for patients with simple hepatic cyst.(4)The population was divided into subgroups according to age and gender,and risk factors of different subgroups were analyzed.?Results?1.Epidemiological investigation of simple hepatic cyst in community population in Shanghai(1)Excluding the subjects with incomplete ultrasound data and over 65 years old,a total of 4065 subjects were included in the community epidemiological survey.(2)Among them,312 patients were diagnosed as simple hepatic cyst,with a prevalence of 7.68%,including 148(47.4%)males and 164(52.6%)females,with a male-female ratio of 1:1.11,and the prevalence of males and females were 8.34% and7.16%,respectively.(3)There were 228 cases of single hepatic cyst and 84 cases of multiple hepatic cysts.The most common site of the cyst was the right anterior lobe of the liver(30.68%).2.The prevalence of simple hepatic cyst in Shanghai Changzheng hospital(1)Excluding patients with incomplete information and repeated abdominal ultrasound examination,a total of 31,154 subjects were included in the study.(2)Among them,7477 patients were diagnosed as hepatic cyst,with a prevalence of24.0%,including 4007(53.6%)males and 3470(46.4%)females.The ratio of male to female was 1:0.87.3.The risk factors of simple hepatic cyst in community-based population(1)The average age,body mass index(BMI),and hormones including follicle-stimulating hormone(FSH)and luteinizing hormone(LH)levels in patients with hepatic cyst were significantly higher than those without hepatic cyst.(2)Subgroup analysis showed that significant increases in FSH and LH were only observed in female younger than 45 years of reproductive age.(3)Univariate logistic regression analysis suggested that smoking(OR =1.616,95%CI =1.251-2.09,P<0.0001),BMI>23.62(OR =1.36,95%CI =1.706-1.763,P=0.005),hypertension(OR =2.352,95%CI =1.776-3.115,P<0.0001),combined with fatty liver disease(OR =2.869,95%CI =1.428-5.767,P=0.003)were possible risk factors for simple hepatic cyst.(4)Multivariate logistic regression analysis suggested that increasing age was an independent risk factor for hepatic cyst(OR = 5.135,95%CI = 3.515-7.504,P < 0.0001).Subgroup analysis suggested that in men younger than 45 years old,increasing age and combined with gallstone were two independent risk factors for hepatic cyst(OR = 2.804,95%CI = 1.294-6.705,P = 0.009;OR = 3.375,95% CI = 1.103-10.332,P = 0.033).In women younger than 45 years old,increasing age and FSH value were two independent risk factors(OR = 3.937,95%CI = 1.678-9.238,P = 0.002,OR = 2.554,95%CI =1.160-5.622,P = 0.020).?Conclusion?1.The prevalence of simple hepatic cyst was 7.68% in community-based population and 24.0% in hospital-based population.2.In the total population,increasing age is an independent risk factor for simple hepatic cyst,while for women younger than 45 years who are at reproductive age,increasing age and FSH value are two independent risk factors.