Giorda Carlo, Forlani Gabriele, Manti Roberta, Mazzella Natalia, De Cosmo Salvatore, Rossi Maria Chiara, Nicolucci Antonio, Russo Giuseppina, Di Bartolo Paolo, Ceriello Antonio, Guida Piero
Diabetes and Metabolism Unit ASL Torino 5, Chieri, Italy.
Unit of Metabolic Diseases and Clinical Dietetics, "Alma Mater Studiorum" University of Bologna, Bologna, Italy.
Diabetes Metab Res Rev. 2017 May;33(4). doi: 10.1002/dmrr.2878. Epub 2017 Jan 27.
This analysis was aimed to assess the incidence, regression, and correlated factors of nonalcoholic fatty liver disease (NAFLD) in type 2 diabetes, which are poorly known.
Nonalcoholic fatty liver disease (defined as fatty liver index [FLI] score ≥ 60) in patients with type 2 diabetes, and related factors was investigated in a nationwide database containing information from the Italian network of diabetes clinics. A 10% variation of FLI was the cut-off considered in the analyses of a cohort of 5030 patients, which was separately conducted for those who developed, maintained, or recovered from FLI-assessed NAFLD (FLI-NAFLD) over a 3-year period.
At baseline, FLI-NAFLD was diagnosed in 61.3% of patients. Within the 3-year study period, FLI-NAFLD occurred in 313 patients and remitted in 410. The FLI score remained unchanged in 4307. Body-mass index (odds ratio, 1.45 95%; confidence interval, 1.35-1.55), abdominal obesity (2.11; 1.64-2.72), low HDL cholesterol levels (1.38; 1.02-1.87), and triglycerides (1.20; 1.12-1.28) all emerged as notable negative prognostic factors for the development or maintenance of FLI-NAFLD. The regression rate of FLI-NAFLD was higher among patients who managed to partially control these factors. Male sex and established organ damage, especially kidney function (1.64; 1.12-2.42), were independent risk predictors. Unlike other diabetes complications, FLI-NAFLD was more frequent among younger patients or those with a shorter duration of diabetes.
FLI-assessed NAFLD is a dynamic condition, with about 5% of diabetic patients entering or leaving the status every year. Younger male patients with insulin resistance or organ damage have a higher risk of presenting with FLI-NAFLD at baseline, developing FLI-NAFLD within 3 years, and a lower probability of regression.
本分析旨在评估2型糖尿病中非酒精性脂肪性肝病（NAFLD）的发病率、缓解情况及相关因素，目前这些情况尚鲜为人知。
在一个包含意大利糖尿病诊所网络信息的全国性数据库中，对2型糖尿病患者的非酒精性脂肪性肝病（定义为脂肪肝指数[FLI]评分≥60）及相关因素进行了研究。在对5030名患者的队列分析中，将FLI 10%的变化作为分析的临界值，该队列分析分别针对在3年期间发生、维持或从FLI评估的NAFLD（FLI-NAFLD）中恢复的患者进行。
基线时，61.3%的患者被诊断为FLI-NAFLD。在3年的研究期内，313名患者发生了FLI-NAFLD，410名患者病情缓解。4307名患者的FLI评分保持不变。体重指数（比值比，1.45；95%置信区间，1.35 - 1.55）、腹型肥胖（2.11；1.64 - 2.72）、低高密度脂蛋白胆固醇水平（1.38；1.02 - 1.87）和甘油三酯（1.20；1.12 - 1.28）均成为FLI-NAFLD发生或维持的显著负性预后因素。在部分控制了这些因素的患者中，FLI-NAFLD的缓解率更高。男性和已有的器官损害，尤其是肾功能（1.64；1.12 - 2.42），是独立的风险预测因素。与其他糖尿病并发症不同，FLI-NAFLD在年轻患者或糖尿病病程较短的患者中更为常见。
FLI评估的NAFLD是一种动态状况，每年约有5%的糖尿病患者进入或脱离该状态。胰岛素抵抗或器官损害的年轻男性患者在基线时出现FLI-NAFLD、在3年内发生FLI-NAFLD的风险更高，而缓解的可能性更低。
