Section of Endocrinology and Metabolism, Department of Medicine, University of Verona, Verona, Italy.
Diabet Med. 2012 Feb;29(2):220-6. doi: 10.1111/j.1464-5491.2011.03427.x.
We determined whether non-alcoholic fatty liver is associated with an increased prevalence of chronic kidney disease in Type 1 diabetes.
We studied 343 patients with Type 1 diabetes, who had no history of excessive alcohol consumption or other secondary causes of chronic liver disease. Non-alcoholic fatty liver was diagnosed by ultrasonography. Chronic kidney disease was defined as presence of either abnormal albuminuria (i.e., urinary albumin/creatinine ratio ≥ 30 mg/g) or estimated glomerular filtration rate of less than 60 ml min(-1) 1.73 m(-2) .
Compared with those without steatosis, patients with non-alcoholic fatty liver (n = 182) had significantly lower estimated GFR (83.0 ± 27 vs. 93.3 ± 29 ml min(-1) 1.73 m(-2) , P < 0.001) and a greater prevalence of abnormal albuminuria (50.0 vs. 20.5%, P < 0.0001) and chronic kidney disease (54.4 vs. 24.2%, P < 0.0001). Multivariable logistic regression analysis revealed that non-alcoholic fatty liver was associated with an increased risk of either abnormal albuminuria (adjusted odds ratio 2.21, 95% CI 1.2-4.1, P = 0.01) or chronic kidney disease (adjusted odds ratio 1.93, 95% CI 1.1-3.6, P = 0.02), independently of age, gender, smoking status, physical activity, diabetes duration, HbA(1c) , BMI, systolic blood pressure, plasma lipids and use of anti-hypertensive and lipid-lowering medications.
Our findings demonstrate that ultrasound-diagnosed non-alcoholic fatty liver is associated with a higher prevalence of chronic kidney disease in patients with Type 1 diabetes, independently of several risk factors, including the components of the metabolic syndrome.
我们旨在确定非酒精性脂肪肝是否与 1 型糖尿病患者慢性肾脏病的患病率增加相关。
我们研究了 343 名 1 型糖尿病患者，这些患者没有过量饮酒或其他慢性肝病的继发原因。通过超声检查诊断非酒精性脂肪肝。慢性肾脏病的定义为存在异常白蛋白尿（即尿白蛋白/肌酐比值≥30mg/g）或估算肾小球滤过率（eGFR）<60ml/min·1.73m²。
与无脂肪性肝病的患者相比，患有非酒精性脂肪肝（n=182）的患者估算肾小球滤过率（eGFR）明显更低（83.0±27 与 93.3±29ml/min·1.73m²，P<0.001），异常白蛋白尿（50.0%与 20.5%，P<0.0001）和慢性肾脏病（54.4%与 24.2%，P<0.0001）的患病率更高。多变量逻辑回归分析显示，非酒精性脂肪肝与异常白蛋白尿（调整后比值比 2.21，95%可信区间 1.2-4.1，P=0.01）或慢性肾脏病（调整后比值比 1.93，95%可信区间 1.1-3.6，P=0.02）的风险增加相关，独立于年龄、性别、吸烟状况、体力活动、糖尿病病程、糖化血红蛋白（HbA1c）、体重指数、收缩压、血脂以及抗高血压和调脂药物的使用。
我们的研究结果表明，超声诊断的非酒精性脂肪肝与 1 型糖尿病患者慢性肾脏病的患病率增加相关，这与多种危险因素有关，包括代谢综合征的组成部分。
