Masarone Mario, Rosato Valerio, Aglitti Andrea, Bucci Tommaso, Caruso Rosa, Salvatore Teresa, Sasso Ferdinando Carlo, Tripodi Marie Francoise, Persico Marcello
Internal Medicine and Hepatology Unit, University of Salerno, Salerno, Italy.
Internal Medicine and Hepatology Department, University of Campania "L. Vanvitelli", Naples, Italy.
PLoS One. 2017 Jun 1;12(6):e0178473. doi: 10.1371/journal.pone.0178473. eCollection 2017.
Recent studies report a prevalence of non-alcoholic fatty liver disease (NAFLD) of between 70% and 80% in patients with metabolic syndrome (MS) and type 2 diabetes mellitus (T2DM). Nevertheless, it is not possible to differentiate between simple steatosis and non-alcoholic steatohepatitis (NASH) with non-invasive tests. The aim of this study was to differentiate between simple steatosis and NASH by liver biopsy in patients with hypertransaminasemia and MS or T2DM. Two hundred and fifteen patients with increased ALT levels and MS, and 136 patients at their first diagnosis of T2DM regardless of ALT values were consecutively admitted to a tertiary hepatology center between January 2004 and November 2014. Exclusion criteria were other causes of liver disease/ALT increase. Each patient underwent a clinical, laboratory and ultrasound evaluation, and a liver biopsy. Gender distribution, age, and body mass index were similar in the two groups of patients, whereas cholesterol levels, glycemia and blood pressure were significantly different between the two groups. The prevalence of NAFLD was 94.82% in MS patients and 100% in T2DM patients. NASH was present in 58.52% of MS patients and 96.82% of T2DM. Consequently, this study reveals that, by using liver biopsy, almost all patients with T2DM or MS have NAFLD, which in patients with T2DM means NASH. Importantly, it suggests that NASH may be one of the early complications of T2DM due to its pathophysiological correlation with insulin resistance.
近期研究报告称，代谢综合征（MS）和2型糖尿病（T2DM）患者中非酒精性脂肪性肝病（NAFLD）的患病率在70%至80%之间。然而，通过非侵入性检查无法区分单纯性脂肪变性和非酒精性脂肪性肝炎（NASH）。本研究的目的是通过肝活检区分高转氨酶血症合并MS或T2DM患者的单纯性脂肪变性和NASH。2004年1月至2014年11月期间，215例ALT水平升高且患有MS的患者以及136例初诊为T2DM的患者（无论ALT值如何）连续入住一家三级肝病中心。排除标准为其他肝病/ALT升高原因。每位患者均接受了临床、实验室和超声评估以及肝活检。两组患者的性别分布、年龄和体重指数相似，而两组之间的胆固醇水平、血糖和血压存在显著差异。MS患者中NAFLD的患病率为94.82%，T2DM患者中为100%。NASH在MS患者中的占比为58.52%，在T2DM患者中为96.82%。因此，本研究表明，通过肝活检，几乎所有T2DM或MS患者都患有NAFLD，而在T2DM患者中这意味着NASH。重要的是，这表明由于NASH与胰岛素抵抗在病理生理上存在关联，它可能是T2DM的早期并发症之一。
