Diabetes and Metabolism Unit ASL Turin 5 Chieri (TO), Italy.
Unit of Metabolic Diseases and Clinical Dietetics, "Alma Mater Studiorum" - University of Bologna, Italy.
Diabetes Res Clin Pract. 2018 Jan;135:65-72. doi: 10.1016/j.diabres.2017.10.023. Epub 2017 Oct 31.
The prevalence and progression of hepatic fibrosis and its correlated factors in type 2 diabetes (T2DM) are poorly known. We aimed to define the percentage of T2DM patients who progress to fibrosis and the factors associated with disease progression.
Data from the electronic health records of 1527 patients with diagnosed T2DM and nonalcoholic fatty liver disease (NAFLD), as diagnosed by the Fatty Liver Index, were extracted from the AMD Annals database, which collects data from the Italian network of diabetes clinics. For the main analysis, we evaluated variables associated with Fibrosis 4 [FIB-4] score at baseline and at 3-year follow-up to determine their role in predicting FIB-4 at 3 years and the risk of hepatic fibrosis in T2DM.
High-risk of advanced fibrosis was detected in 13.1% of patients at baseline and in 18.1% at 3 years, LDL cholesterol, and body-mass index, correlated negatively with baseline FIB-4 scores, whereas gamma glutamil transerasi correlated positively . The FIB-4 score at 3 years was associated with lower values of baseline renal function, LDL, and BMI; however, the baseline FIB-4 score was the strongest predictor for the FIB-4 score at 3 years.
The prevalence of and progression to hepatic fibrosis within 3 years in patients with T2DM is not negligible. Patients with a higher likelihood of liver scarring differ from those with hepatic steatosis. Differently from NAFLD, the FIB-4 score is inversely correlated with insulin resistance and appears to increase independent of classic metabolic factors.
2 型糖尿病（T2DM）患者肝纤维化的流行程度和进展及其相关因素知之甚少。我们旨在确定进展为纤维化的 T2DM 患者的百分比以及与疾病进展相关的因素。
从 AMD 档案数据库中提取了 1527 例诊断为 T2DM 和非酒精性脂肪性肝病（NAFLD）的患者的电子健康记录数据，NAFLD 通过脂肪性肝病指数诊断。在主要分析中，我们评估了与基线和 3 年随访时的 FIB-4 评分相关的变量，以确定它们在预测 3 年后的 FIB-4 评分和 T2DM 肝纤维化风险方面的作用。
基线时高危进展性肝纤维化的患者为 13.1%，3 年后为 18.1%，LDL 胆固醇和体重指数与基线 FIB-4 评分呈负相关，而γ谷氨酰转肽酶与基线 FIB-4 评分呈正相关。3 年后的 FIB-4 评分与较低的基线肾功能、LDL 和 BMI 值相关，但基线 FIB-4 评分是预测 3 年后 FIB-4 评分的最强指标。
T2DM 患者在 3 年内肝纤维化的流行程度和进展程度不可忽视。有较高肝脏瘢痕形成可能性的患者与有肝脂肪变性的患者不同。与 NAFLD 不同，FIB-4 评分与胰岛素抵抗呈负相关，并且似乎独立于经典代谢因素而增加。
