经活检证实的非酒精性脂肪性肝病合并或不合并2型糖尿病患者的组织病理学差异。

Histopathological differences in patients with biopsy-proven non-alcoholic fatty liver disease with and without type 2 diabetes.

作者信息

Aller de la Fuente Rocío, Mora Cuadrado Natalia, Tafur Carla, López Gómez Juan Jose, Gómez de la Cuesta Sara, García Sánchez María Concepción, Antolin Melero Beatriz, de Luis Román Daniel Antonio

机构信息

Hospital Clinico Universitario, Gastroenterology, Valladolid, Spain.

出版信息

Endocrinol Diabetes Nutr (Engl Ed). 2018 Jun-Jul;65(6):354-360. doi: 10.1016/j.endinu.2017.12.011. Epub 2018 Feb 21.

DOI:10.1016/j.endinu.2017.12.011

PMID:29477355

Abstract

BACKGROUND AND AIMS

Prevalence of non-alcoholic fatty liver disease (NAFLD) in developed countries is 30% in the general population and 50% in patients with type 2 diabetes mellitus (T2DM). The aim of this study was to compare the severity of NAFLD, as assessed by liver biopsy and using the non-invasive index NAFLD Fibrosis Score (NFS), in subjects with and without T2DM.

PATIENTS AND METHODS

The study sample consisted of 217 patients with biopsy-proven NAFLD. Anthropometric assessments, laboratory tests, histological criteria established by the Non-alcoholic Steatohepatitis Clinical Research Network (NASH CRN), and the NFS were recorded.

RESULTS

Patients with T2DM (n=36; 16.5%) had higher HOMA-IR values (6.3±3.6 vs. 3.3±2.4; p<0.0001), GGT levels (125.2±102.3 vs. 82.5±70.6IU/l; p<005), and NFS index (-0.6±0.2 vs. -1.8±0.1; p<0.001) than subjects with no T2DM. Patients with T2DM were found higher rates of NASH (72.2% vs. 48.6%; p<0.05), advanced steatosis (80.6% vs. 63%; p<0.05), and liver fibrosis (75% vs. 43.1%, p<0.05) than patients with no T2DM. Patients with T2DM also had higher NFS values (-0.6±1.2 vs. -1.8±1.8: p=0.01). A logistic regression analysis adjusting for age, gender and BMI showed a significant independent association between NASH and presence of T2DM (OR=4.2: 95% CI: 1.4-12.1; p=0.007). A second model adjusting for the same covariates showed T2DM to be an independent factor associated to advanced fibrosis (OR=4.1; 95% CI: 1.7-9.7).

CONCLUSION

Patients with T2DM have more advanced degrees of NAFLD and advanced fibrosis as assessed by liver biopsy and the NFS index. Particular attention should be paid to the study and monitoring of NASH in patients with T2DM.

摘要

背景与目的

在发达国家，普通人群中非酒精性脂肪性肝病（NAFLD）的患病率为30%，2型糖尿病（T2DM）患者中的患病率为50%。本研究的目的是比较经肝活检评估以及使用非侵入性指标NAFLD纤维化评分（NFS）评估的NAFLD严重程度在有和没有T2DM的受试者中的差异。

患者与方法

研究样本包括217例经活检证实为NAFLD的患者。记录人体测量评估、实验室检查结果、非酒精性脂肪性肝炎临床研究网络（NASH CRN）制定的组织学标准以及NFS。

结果

T2DM患者（n = 36；16.5%）的稳态模型评估胰岛素抵抗（HOMA-IR）值（6.3±3.6 vs. 3.3±2.4；p<0.0001）、γ-谷氨酰转移酶（GGT）水平（125.2±102.3 vs. 82.5±70.6IU/l；p<0.05）和NFS指数（-0.6±0.2 vs. -1.8±0.1；p<0.001）均高于无T2DM的受试者。发现T2DM患者的非酒精性脂肪性肝炎（NASH）发生率（72.2% vs. 48.6%；p<0.05）、重度脂肪变性（80.6% vs. 63%；p<0.05）和肝纤维化发生率（75% vs. 43.1%，p<0.05）均高于无T2DM的患者。T2DM患者的NFS值也更高（-0.6±1.2 vs. -1.8±1.8：p = 0.01）。对年龄、性别和体重指数进行校正的逻辑回归分析显示，NASH与T2DM的存在之间存在显著的独立关联（比值比[OR]=4.2：95%置信区间[CI]：1.4 - 12.1；p = 0.007）。调整相同协变量的第二个模型显示，T2DM是与晚期纤维化相关的独立因素（OR = 4.1；95% CI：1.7 - 9.7）。