Zhao Hongli, Song Xiangxin, Li Zhang, Wang Xinling
Department of Endocrinology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi Department of Medicine, Xinjiang Altay Region People's Hospital, Altay, Xinjiang, P.R. China.
Medicine (Baltimore). 2018 Sep;97(37):e12356. doi: 10.1097/MD.0000000000012356.
Type 2 diabetes mellitus (T2DM) is closely related to hepatic steatosis and fibrosis. The aim of this study was to analyze the occurrence of hepatic steatosis and fibrosis in patients with T2DM and to explore the risk factors.A total of 629 patients with T2DM were enrolled. Liver stiffness value (LSV) and controlled attenuation parameters (CAP) were measured using Fibroscan. Liver fibrosis was diagnosed when LSV was greater than 7.4 kPa, and advanced liver fibrosis was diagnosed when LSV was greater than 10.6 kPa. Hepatic steatosis diagnosis was made when CAP value was greater than 238 dB/m. Demographic information, physical examination data, and laboratory tests results were collected. The 629 patients were classified into 2 groups by the liver fibrosis and liver steatosis, and then the difference was analyzed.Among patients enrolled, 231 patients were diagnosed as liver fibrosis. The age of the patients in the fibrosis group was significantly greater than that in the non-fibrosis group, and similar trends were observed in the waist-hip ratio (WHR), systolic blood pressure, and diastolic blood pressure. The proportion of smoking and alcoholic consumption was significantly lower in patients with non-fibrosis group. A total of 426 patients were diagnosed with liver steatosis. Body mass index (BMI), WHR, systolic blood pressure, and diastolic blood pressure in patients with steatosis were significantly higher than those in non-steatosis group. We observed that the LSV (P = .042) and CAP value (P < .001) are positively correlated with metabolic syndrome components in T2DM patients. Older age (OR = 1.099, P = .001), high BMI (OR = 1.088, P = .003), low platelet level (OR = 0.996, P = .014), and smoking (OR = 1.653, P = .013) were independent risk factors of liver fibrosis among T2DM patients. High BMI (OR = 1.369, P < .001), high diastolic blood pressure (OR = 1.048, P < .001), and high gamma glutamyl transpeptidase (OR = 1.018, P = .009) were independent risk factors for liver steatosis among T2DM patients.This study suggested risk factors screening of liver fibrosis and steatosis. Timely intervention should be taken into consideration among high risk patients to prevent progress liver diseases.
2型糖尿病（T2DM）与肝脂肪变性和肝纤维化密切相关。本研究旨在分析T2DM患者肝脂肪变性和肝纤维化的发生情况，并探讨其危险因素。共纳入629例T2DM患者。使用Fibroscan测量肝脏硬度值（LSV）和受控衰减参数（CAP）。当LSV大于7.4 kPa时诊断为肝纤维化，当LSV大于10.6 kPa时诊断为进展性肝纤维化。当CAP值大于238 dB/m时诊断为肝脂肪变性。收集人口统计学信息、体格检查数据和实验室检查结果。将629例患者按肝纤维化和肝脂肪变性分为2组，然后分析差异。纳入的患者中，231例被诊断为肝纤维化。纤维化组患者的年龄显著高于非纤维化组，腰围臀围比（WHR）、收缩压和舒张压也有类似趋势。非纤维化组患者的吸烟和饮酒比例显著较低。共有426例患者被诊断为肝脂肪变性。脂肪变性患者的体重指数（BMI）、WHR、收缩压和舒张压显著高于非脂肪变性组。我们观察到，T2DM患者的LSV（P = 0.042）和CAP值（P < 0.001）与代谢综合征组分呈正相关。年龄较大（OR = 1.099，P = 0.001）、高BMI（OR = 1.088，P = 0.003）、低血小板水平（OR = 0.996，P = 0.014）和吸烟（OR = 1.653，P = 0.013）是T2DM患者肝纤维化的独立危险因素。高BMI（OR = 1.369，P < 0.001）、高舒张压（OR = 1.048，P < 0.001）和高γ-谷氨酰转肽酶（OR = 1.018，P = 0.009）是T2DM患者肝脂肪变性的独立危险因素。本研究提出了肝纤维化和肝脂肪变性的危险因素筛查。对于高危患者应考虑及时干预，以预防肝病进展。
