Singh Amandeep, Le Phuc, Peerzada Maajid M, Lopez Rocio, Alkhouri Naim
Department of Hospital Medicine, Medicine Institute.
Department of Quantitative Health Sciences, Lerner Research Institute.
J Clin Gastroenterol. 2018 Mar;52(3):268-272. doi: 10.1097/MCG.0000000000000905.
The aim of our study is to assess the prevalence of nonalcoholic fatty liver disease (NAFLD) and advanced hepatic fibrosis in patients with type 2 diabetes mellitus (T2DM) using simple noninvasive scores.
In individuals with T2DM, there is a very high prevalence of NAFLD. Moreover, T2DM is a risk factor for advanced disease in NAFLD patients.
Using International Classification of Diseases, Ninth Revision codes all patients with the diagnosis of T2DM were reviewed and a retrospective chart analysis was performed on 169,910 patients between the ages of 18 to 80. To predict the prevalence of NAFLD, we calculated the hepatic steatosis index. To estimate the prevalence of advanced fibrosis, NAFLD fibrosis score (NFS), fibrosis-4 index, aspartate aminotransferase (AST) to platelet ratio index (APRI), and AST/alanine aminotransferase (ALT) ratio were calculated.
Of the 121,513 patients included in the analysis, 89.4% were above normal weight limit. NAFLD based on Hepatic Steatosis Index>36 was present in 87.9% of patients. Advanced fibrosis was present in 35.4% based on NFS>0.676, 8.4% based on fibrosis-4>2.67, 1.9% based on APRI>1.5, and 16.9% based on AST/ALT>1.4% indicating advanced fibrosis and high risk of developing cirrhosis related to NAFLD.
In this large cohort of patients with T2DM, we detected high prevalence of hepatic steatosis and advanced fibrosis using noninvasive scores. These scores are easy and nonexpensive tools to screen for NAFLD and advanced fibrosis, although the significant variability of the percentage of patients with advanced fibrosis using these scores indicates the need for further validation in diabetic populations.
我们研究的目的是使用简单的非侵入性评分来评估2型糖尿病（T2DM）患者中非酒精性脂肪性肝病（NAFLD）和晚期肝纤维化的患病率。
在T2DM患者中，NAFLD的患病率非常高。此外，T2DM是NAFLD患者发生晚期疾病的危险因素。
使用国际疾病分类第九版编码，对所有诊断为T2DM的患者进行了回顾，并对169910名年龄在18至80岁之间的患者进行了回顾性图表分析。为了预测NAFLD的患病率，我们计算了肝脂肪变性指数。为了估计晚期纤维化的患病率，计算了NAFLD纤维化评分（NFS）、纤维化-4指数、天冬氨酸转氨酶（AST）与血小板比值指数（APRI）以及AST/丙氨酸转氨酶（ALT）比值。
在纳入分析的121513名患者中，89.4%超过正常体重范围。基于肝脂肪变性指数>36的NAFLD在87.9%的患者中存在。基于NFS>0.676，晚期纤维化在35.4%的患者中存在；基于纤维化-4>2.67，在8.4%的患者中存在；基于APRI>1.5，在1.9%的患者中存在；基于AST/ALT>1.4%，在16.9%的患者中存在，表明存在晚期纤维化以及发生与NAFLD相关肝硬化的高风险。
在这个大型T2DM患者队列中，我们使用非侵入性评分检测到肝脂肪变性和晚期纤维化的高患病率。这些评分是筛查NAFLD和晚期纤维化的简便且廉价的工具，尽管使用这些评分时晚期纤维化患者百分比存在显著差异，这表明需要在糖尿病人群中进一步验证。
