Department of Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.
Obesity Treatment Center, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
Ann Hepatol. 2018;17(4):585-591. doi: 10.5604/01.3001.0012.0922.
The prevalence of obesity, type 2 diabetes mellitus and non-alcoholic fatty liver disease are increasing. Type 2 diabetes mellitus may aggravate non-alcoholic fatty liver disease, increasing the risk of developing cirrhosis and hepatocellular carcinoma. This study aims to determine the effect of type 2 diabetes mellitus and insulin therapy on non-alcoholic fatty liver disease in the patients with morbid obesity.
Clinical, anthropometric and laboratory data were analyzed together with intraoperative liver biopsies from morbidly obese patients undergoing bariatric surgery.
219 patients with morbid obesity were evaluated. Systemic arterial hypertension (55.9% vs. 33.8%, p = 0.004) and dyslipidemia (67.1% vs. 39.0%, p < 0.001) were more prevalent in patients with diabetes when compared to patients without diabetes. In multivariate analysis, type 2 diabetes mellitus was an independent risk factor for severe steatosis (RR = 2.04, p = 0.023) and severe fibrosis (RR = 4.57, p = 0.013). Insulin therapy was significantly associated with non-alcoholic steatohepatitis (RR = 1.89, p = 0.001) and fibrosis (RR = 1.75, p = 0.050) when all patients were analysed, but when only patients with diabetes were analysed, insulin therapy was not associated with non-alcoholic steatohepatitis or fibrosis.
Type 2 diabetes mellitus plays an important role in the progression of non-alcoholic fatty liver disease as an independent risk factor for severe fibrosis.
肥胖、2 型糖尿病和非酒精性脂肪性肝病的患病率正在上升。2 型糖尿病可能会加重非酒精性脂肪性肝病，增加发展为肝硬化和肝细胞癌的风险。本研究旨在确定 2 型糖尿病和胰岛素治疗对病态肥胖患者非酒精性脂肪性肝病的影响。
分析了接受减重手术的病态肥胖患者的临床、人体测量学和实验室数据以及术中肝活检。
共评估了 219 例病态肥胖患者。与无糖尿病的患者相比，患有糖尿病的患者更常患有系统性动脉高血压（55.9%比 33.8%，p = 0.004）和血脂异常（67.1%比 39.0%，p < 0.001）。多变量分析显示，2 型糖尿病是严重脂肪变性（RR = 2.04，p = 0.023）和严重纤维化（RR = 4.57，p = 0.013）的独立危险因素。当所有患者均进行分析时，胰岛素治疗与非酒精性脂肪性肝炎（RR = 1.89，p = 0.001）和纤维化（RR = 1.75，p = 0.050）显著相关，但当仅分析糖尿病患者时，胰岛素治疗与非酒精性脂肪性肝炎或纤维化无关。
2 型糖尿病作为严重纤维化的独立危险因素，在非酒精性脂肪性肝病的进展中起重要作用。
