Inoue Megumi, Oribe Junya, Seike Masataka, Masaki Takayuki, Endo Mizuki, Tokoro Masanori, Yoshihara Mie, Honda Koichi, Shin Rie, Abe Katsunari, Abe Nobuyuki, Yoshimatsu Hironobu
Department of Internal Medicine 1, Faculty of Medicine, Oita University, 1-1, Idaigaoka, Yufu, Oita, 879-5593, Japan.
Abe Clinic, 16-13, Nakakasuga, Oita, Oita, 870-0039, Japan.
Hepatol Int. 2013 Jun;7(2):555-61. doi: 10.1007/s12072-012-9366-3. Epub 2012 Apr 5.
We investigated whether fatty liver (FL) disease in type 2 diabetic mellitus (T2DM) patients affects their incidence of macrovascular disease. In addition, we detected a useful marker for predicting the incidence of macrovascular disease events.
A total of 458 patients who underwent abdominal ultrasonography (US) between April 2003 and March 2004 in a diabetic clinic were divided into FL (n = 211) and non-FL (NFL; n = 247) groups, and followed by a diabetologist and/or hepatologist for 5 years.
No significant difference in the incidence of macrovascular disease, neither cerebrovascular disease nor coronary heart disease, was observed between FL and NFL patients. Interestingly, in FL diabetic patients, only an alanine aminotransferase (ALT) level ≥30 IU/l was significantly associated with the incidence of macrovascular events in univariate (odds ratio [OR], 10.632; 95 % confidence interval [CI], 1.302-86.841; p = 0.0274) and multivariate (OR, 10.134; CI 1.223-83.995; p = 0.0318) analyses. Patients with higher ALT levels had a higher cumulative incidence of macrovascular disease events than did those with lower ALT levels (p = 0.0068). In conclusion, an ALT level ≥30 IU/l is an independent risk indicator of macrovascular disease in diabetic patients with FLD, whereas the presence of FL itself in T2DM patients is not associated with an increased incidence of macrovascular events.
Our findings indicate that therapeutic interventions may be necessary for FL patients with high ALT levels to prevent macrovascular disease.
我们研究了2型糖尿病（T2DM）患者的脂肪肝（FL）疾病是否会影响其大血管疾病的发生率。此外，我们检测了一种用于预测大血管疾病事件发生率的有用标志物。
2003年4月至2004年3月期间在一家糖尿病诊所接受腹部超声检查（US）的458例患者被分为FL组（n = 211）和非FL组（NFL；n = 247），并由糖尿病专家和/或肝病专家随访5年。
FL患者和NFL患者在大血管疾病（包括脑血管疾病和冠心病）的发生率上没有显著差异。有趣的是，在FL糖尿病患者中，仅丙氨酸氨基转移酶（ALT）水平≥30 IU/l在单因素分析（比值比[OR]，10.632；95%置信区间[CI]，1.302 - 86.841；p = 0.0274）和多因素分析（OR，10.134；CI 1.223 - 83.995；p = 0.0318）中与大血管事件的发生率显著相关。ALT水平较高的患者比ALT水平较低的患者大血管疾病事件的累积发生率更高（p = 0.0068）。总之，ALT水平≥30 IU/l是FLD糖尿病患者大血管疾病的独立风险指标，而T2DM患者中FL的存在本身与大血管事件发生率的增加无关。
我们的研究结果表明，对于ALT水平高的FL患者，可能需要进行治疗干预以预防大血管疾病。
