Arase Yasuji, Suzuki Fumitaka, Ikeda Kenji, Kumada Hiromitsu, Tsuji Hiroshi, Kobayashi Tetsuro
Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan.
J Gastroenterol. 2009;44(10):1064-70. doi: 10.1007/s00535-009-0091-1. Epub 2009 Jun 17.
Diabetes is present in patients with nonalcoholic fatty liver disease (NAFLD). The aim of this retrospective cohort study was to assess the cumulative development of type 2 diabetes and predictive factors for its development in Japanese patients with NAFLD.
A total of 6003 NAFLD patients diagnosed by ultrasonography were enrolled. The mean follow-up period was 4.9 years. An overnight (12 h) fasting blood sample or a casual blood sample was taken for routine analyses during follow up. The primary outcome was the development of type 2 diabetes. Evaluation was performed by using the Kaplan-Meier method and Cox proportional hazards analysis.
Of the 6003 NAFLD patients, 411 patients developed type 2 diabetes. The cumulative development rate of type 2 diabetes was 6.8% at the 5th year and 17.7% at the 10th year. Multivariate Cox proportional hazards analysis showed that type 2 diabetes development in patients with NAFLD occurred when patients had prediabetes status (hazard ratio 6.39; 95% confidence interval 5.00-8.18; P < 0.001), mean serum gamma-glutamyltransferase (GGT) level of more than 109 IU/l (hazard ratio 1.60; 95% confidence interval 1.22-2. 02; P < 0.001), mean serum triglyceride (TG) level of more than 150 mg/l (hazard ratio 1.28; 95% confidence interval 1.05-1.55; P = 0.020), and physical activity of less than 60 min per week (hazard ratio 1.60; 95% confidence interval 1.25-2.00; P < 0.001).
The improvement of prediabetes status and physical activity, and the normalization of mean GGT and TG levels during follow up are important to prevent the development of T2DM in patients with NAFLD.
非酒精性脂肪性肝病（NAFLD）患者中存在糖尿病。这项回顾性队列研究的目的是评估日本NAFLD患者2型糖尿病的累积发病率及其发病的预测因素。
共纳入6003例经超声诊断的NAFLD患者。平均随访期为4.9年。随访期间采集过夜（12小时）空腹血样或随机血样进行常规分析。主要结局是2型糖尿病的发生。采用Kaplan-Meier法和Cox比例风险分析进行评估。
6003例NAFLD患者中，411例发生2型糖尿病。2型糖尿病的累积发病率在第5年为6.8%，在第10年为17.7%。多因素Cox比例风险分析显示，NAFLD患者出现2型糖尿病的情况为：有糖尿病前期状态（风险比6.39；95%置信区间5.00-8.18；P<0.001）、平均血清γ-谷氨酰转移酶（GGT）水平超过109 IU/l（风险比1.60；95%置信区间1.22-2.02；P<0.001）、平均血清甘油三酯（TG）水平超过150 mg/l（风险比1.28；95%置信区间1.05-1.55；P=0.020）以及每周体力活动少于60分钟（风险比1.60；95%置信区间1.25-2.00；P<0.001）。
改善糖尿病前期状态和体力活动，以及随访期间使平均GGT和TG水平正常化，对于预防NAFLD患者发生2型糖尿病很重要。
