Wong V W S, Hui A Y, Tsang S W C, Chan J L Y, Wong G L H, Chan A W H, So W Y, Cheng A Y S, Tong P C Y, Chan F K L, Sung J J Y, Chan H L Y
Institute of Digestive Diseases, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong SAR.
Aliment Pharmacol Ther. 2006 Oct 15;24(8):1215-22. doi: 10.1111/j.1365-2036.2006.03112.x.
Non-alcoholic fatty liver disease is prevalent in affluent countries and is strongly associated with metabolic syndrome.
To study the prevalence of undiagnosed diabetes and postchallenge hyperglycaemia in Chinese patients with non-alcoholic fatty liver disease.
73 consecutive patients with biopsy-proven non-alcoholic fatty liver disease and no history of diabetes underwent comprehensive metabolic screening. Diagnosis of diabetes and impaired glucose regulation was based on the 2006 American Diabetes Association criteria.
The prevalence of undiagnosed diabetes and impaired glucose tolerance in non-alcoholic fatty liver disease patients was 33% and 29%, respectively. Among patients with 2-h plasma glucose above 7.8 mm, 47% had normal fasting glucose (below 5.6 mm). Impaired glucose tolerance was more common in patients with non-alcoholic steatohepatitis than those with simple hepatic steatosis (P = 0.036), and 2-h plasma glucose correlated with fibrosis stage (Spearman coefficient: 0.25, P = 0.046). In a binary logistic regression analysis, high fasting glucose and low high-density lipoprotein cholesterol were independent factors associated with diabetes. Nevertheless, if oral glucose tolerance test was only performed in non-alcoholic fatty liver disease patients with impaired fasting glucose, 20.8% of diabetes cases would be missed.
Isolated postchallenge hyperglycaemia is common among Chinese non-alcoholic fatty liver disease patients without history of diabetes. It is associated with histological severe disease, and cannot be accurately predicted by any fasting glucose cut-off.
非酒精性脂肪性肝病在富裕国家普遍存在，且与代谢综合征密切相关。
研究中国非酒精性脂肪性肝病患者中未诊断糖尿病及餐后高血糖的患病率。
对73例经活检证实为非酒精性脂肪性肝病且无糖尿病病史的患者进行全面代谢筛查。糖尿病和糖调节受损的诊断依据2006年美国糖尿病协会标准。
非酒精性脂肪性肝病患者中未诊断糖尿病和糖耐量受损的患病率分别为33%和29%。在2小时血浆葡萄糖高于7.8 mmol/L的患者中，47%的患者空腹血糖正常（低于5.6 mmol/L）。非酒精性脂肪性肝炎患者糖耐量受损比单纯性肝脂肪变性患者更常见（P = 0.036），且2小时血浆葡萄糖与纤维化分期相关（Spearman系数：0.25，P = 0.046）。在二元逻辑回归分析中，空腹血糖高和高密度脂蛋白胆固醇低是与糖尿病相关的独立因素。然而，如果仅对空腹血糖受损的非酒精性脂肪性肝病患者进行口服葡萄糖耐量试验，将漏诊20.8%的糖尿病病例。
在中国无糖尿病病史的非酒精性脂肪性肝病患者中，孤立性餐后高血糖很常见。它与组织学上的严重疾病相关，且不能通过任何空腹血糖切点准确预测。
