Department of Internal Medicine, Medical School and University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Liver Int. 2011 May;31(5):700-6. doi: 10.1111/j.1478-3231.2011.02482.x. Epub 2011 Feb 20.
BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in type 2 diabetes mellitus (T2DM). However, data regarding the prevalence and correlates of its histopathological stages are scarce. The aim was to investigate the prevalence and correlates of the more severe histopathological features of NAFLD, nonalcoholic steatohepatitis (NASH) and advanced fibrosis, in T2DM.
From 125 patients with ultrasonographic evidence of NAFLD, 98 patients underwent liver biopsies, which were examined by two independent pathologists regarding the presence of NASH and graded according to the NASH Clinical Research Network scoring system. Agreement between pathologists was assessed by weighted κ coefficients and independent correlates of NASH and advanced fibrosis (grade ≥ 2) by multivariate logistic regression.
Ninety-two (94%) patients presented histological NAFLD. Interobserver agreement was substantial to excellent for NASH diagnosis (κ=0.82) and steatosis grading (κ=0.76), and moderate for the NAFLD activity score (κ=0.58) and fibrosis grading (κ=0.52). The prevalence of NASH was 78%, and its independent correlates were hypertriglyceridaemia (P=0.034), high alanine aminotranferase level (P=0.044) and low serum high-density lipoprotein-cholesterol (P=0.079). The prevalence of advanced fibrosis ranged from 34% in the best scenario (lowest fibrosis score) to 60% in the worst scenario (highest score). Its independent correlates were a high serum γ-glutamyl transferase (P=0.002), older age (P=0.022) and male gender (P=0.064). No diabetes-related clinical characteristic was associated with NASH or advanced liver fibrosis.
The prevalence of the severe features of NAFLD is high in T2DM patients. Liver biopsy shall be considered in all diabetic patients with ultrasonographic evidence of NAFLD.
背景/目的：非酒精性脂肪性肝病（NAFLD）在 2 型糖尿病（T2DM）中极为普遍。然而，有关其组织病理学分期的患病率和相关因素的数据却很少。本研究旨在调查 T2DM 患者中更严重的 NAFLD、非酒精性脂肪性肝炎（NASH）和肝纤维化的组织病理学特征的患病率和相关因素。
从 125 例超声检查有 NAFLD 证据的患者中，98 例患者接受了肝活检，由两名独立的病理学家检查 NASH 的存在，并根据 NASH 临床研究网络评分系统进行分级。通过加权 κ 系数评估病理学家之间的一致性，并通过多变量逻辑回归分析 NASH 和高级纤维化（≥2 级）的独立相关因素。
92 例（94%）患者存在组织学 NAFLD。病理学家之间对 NASH 诊断（κ=0.82）和脂肪变性分级（κ=0.76）的一致性为强至极好，对 NAFLD 活动评分（κ=0.58）和纤维化分级（κ=0.52）的一致性为中度。NASH 的患病率为 78%，其独立相关因素为高甘油三酯血症（P=0.034）、高丙氨酸氨基转移酶水平（P=0.044）和低血清高密度脂蛋白胆固醇（P=0.079）。高级纤维化的患病率从最佳情况（最低纤维化评分）的 34%到最差情况（最高评分）的 60%不等。其独立相关因素为血清 γ-谷氨酰转移酶升高（P=0.002）、年龄较大（P=0.022）和男性（P=0.064）。没有与糖尿病相关的临床特征与 NASH 或晚期肝纤维化相关。
T2DM 患者中 NAFLD 严重特征的患病率较高。对于超声检查有 NAFLD 证据的所有糖尿病患者，均应考虑进行肝活检。
