Seko Yuya, Sumida Yoshio, Tanaka Saiyu, Mori Kojiroh, Taketani Hiroyoshi, Ishiba Hiroshi, Hara Tasuku, Okajima Akira, Umemura Atsushi, Nishikawa Taichiro, Yamaguchi Kanji, Moriguchi Michihisa, Kanemasa Kazuyuki, Yasui Kohichiroh, Imai Shunsuke, Shimada Keiji, Itoh Yoshito
Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University, Aichi, Japan.
Hepatol Res. 2018 Feb;48(3):E42-E51. doi: 10.1111/hepr.12925. Epub 2017 Jul 20.
Type 2 diabetes mellitus (T2DM) is a major complication of patients with non-alcoholic fatty liver disease (NAFLD). The aim of this retrospective study is to determine the risk factors for development of T2DM in patients with biopsy-proven NAFLD.
One hundred and sixty two consecutive patients with biopsy-proven NAFLD who received a 75-g oral glucose tolerance test were enrolled as the total cohort. Among them, we analyzed 89 patients without T2DM diagnosed by oral glucose tolerance test to estimate the cumulative rate for development of T2DM as the follow-up cohort.
Of 162 patients, the glucose tolerance pattern were DM in 45 patients (27.8%), impaired glucose tolerance in 68 (42.0%), and normal glucose tolerance in 49 (30.2%). Patients with NAFL tended to be more likely to have normal glucose tolerance than those with non-alcoholic steatohepatitis (NASH). The serum levels of pre- and post-load insulin were significantly higher in the NASH group. Of 89 patients without T2DM, 13 patients newly developed T2DM during a follow-up period of 5.2 years. The cumulative rate of T2DM incidence was 8.8% at the end of the 5th year and 23.4% at the end of the 10th year. Multivariate analysis identified homeostasis model of assessment - insulin resistance (≥3.85, hazard ratio 40.1, P = 0.033) as an independent risk factor for development of T2DM.
Patients with NASH have an underlying potential of glucose intolerance. In NAFLD patients, insulin resistance is the most important risk factor for the incidence of T2DM. Appropriate therapy against insulin resistance could be needed for patients with NAFLD to prevent development of T2DM.
2型糖尿病（T2DM）是非酒精性脂肪性肝病（NAFLD）患者的主要并发症。本回顾性研究的目的是确定经活检证实的NAFLD患者发生T2DM的危险因素。
连续纳入162例经活检证实的NAFLD患者，这些患者接受了75克口服葡萄糖耐量试验，作为总队列。其中，我们分析了89例经口服葡萄糖耐量试验诊断为无T2DM的患者，作为随访队列来估计T2DM发生的累积率。
162例患者中，葡萄糖耐量模式为糖尿病的有45例（27.8%），糖耐量受损的有68例（42.0%），糖耐量正常的有49例（30.2%）。与非酒精性脂肪性肝炎（NASH）患者相比，NAFL患者糖耐量正常的可能性更大。NASH组负荷前后的血清胰岛素水平显著更高。在89例无T2DM的患者中，13例在5.2年的随访期内新发生了T2DM。第5年末T2DM发病率的累积率为8.8%，第10年末为23.4%。多变量分析确定评估胰岛素抵抗的稳态模型（≥3.85，风险比40.1，P = 0.033）是发生T2DM的独立危险因素。
NASH患者有潜在的糖耐量异常。在NAFLD患者中，胰岛素抵抗是T2DM发病的最重要危险因素。NAFLD患者可能需要采取适当的抗胰岛素抵抗治疗以预防T2DM的发生。
