Mandal Amrendra, Bhattarai Bikash, Kafle Paritosh, Khalid Mazin, Jonnadula Saikiran K, Lamicchane Jenny, Kanth Rajan, Gayam Vijay
Internal Medicine, Interfaith Medical Center, Brooklyn, USA.
Internal Medicine, St. John Riverside Hospital, Yonkers, USA.
Cureus. 2018 Nov 23;10(11):e3626. doi: 10.7759/cureus.3626.
Background Non-alcoholic fatty liver disease (NAFLD) is emerging as the most common chronic liver condition. Approximately 70% of type 2 diabetes mellitus (T2DM) patients have a fatty liver; the progression to non-alcoholic steatohepatitis (NASH) dramatically increases the risks of cirrhosis and hepatocellular carcinoma. The aim of our study was to assess the profile of liver enzymes in subjects with T2DM and NAFLD. Method This was a cross-sectional clinic-based study in patients with T2DM. An ultrasonography of the abdomen was done in all patients in order to examine the presence of a fatty liver. Body mass index (BMI), lipid profile, and liver enzymes were also analyzed in all patients. Institutional Review Board (IRB) approval was provided by the National Academy of Medical Sciences, Bir Hospital, Nepal. Unpaired -test, Chi-square/Fisher's exact test (for categorical variables), and the Pearson/Spearman correlation test were used to find a significant difference, association, and correlation between two or more groups, respectively. The Statistical Package for Social Sciences (SPSS)® Statistics, version 16 (IBM SPSS Statistics, Armonk, NY) was used to analyse the data. Results The study was carried out in 210 patients, and out of the 210 patients, 119 (56.6%) were male and 91 (43.3%) were female. The patients were divided into two groups, i.e., the normal alanine aminotransferase (ALT) group and the elevated ALT group. The mean age of the patients was 56.28 ± 12.3 years in the normal alanine aminotransferase (ALT) group and 58.6 ± 24.7 in the elevated ALT group. The number of T2DM patients with a fatty liver was 117 (55.7%) and those with a non-fatty liver was 93 (44.2%) based on an ultrasonography scan. Subjects with NAFLD had a significantly higher ALT (p < 0.001) but no significant rise in serum aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), and alkaline phosphatase (ALP) levels. The area under the receiver operating characteristic (AUROC) curve for the prediction of fatty liver based solely on the ALT was 0.84 with the confidence interval (CI) between 0.76 and 0.92 (p < 0.05). Conclusions Non-alcoholic fatty liver disease is highly prevalent in patients with T2DM. Timely diagnosis and management of the abnormal liver parameters may help to minimize liver-related morbidity and mortality in the diabetic population.
背景 非酒精性脂肪性肝病（NAFLD）正成为最常见的慢性肝脏疾病。约70%的2型糖尿病（T2DM）患者患有脂肪肝；进展为非酒精性脂肪性肝炎（NASH）会显著增加肝硬化和肝细胞癌的风险。我们研究的目的是评估T2DM和NAFLD患者的肝酶谱。方法 这是一项针对T2DM患者的基于临床的横断面研究。对所有患者进行腹部超声检查以检测脂肪肝的存在。还对所有患者分析了体重指数（BMI）、血脂谱和肝酶。尼泊尔加德满都医学院附属比尔医院的医学科学院提供了机构审查委员会（IRB）的批准。分别使用不成对t检验、卡方/费舍尔精确检验（用于分类变量）以及皮尔逊/斯皮尔曼相关性检验来发现两组或多组之间的显著差异、关联和相关性。使用社会科学统计软件包（SPSS）® Statistics 16版（IBM SPSS Statistics，纽约州阿蒙克）分析数据。结果 该研究纳入了210例患者，其中119例（56.6%）为男性，91例（43.3%）为女性。患者被分为两组，即正常丙氨酸氨基转移酶（ALT）组和ALT升高组。正常ALT组患者的平均年龄为56.28±12.3岁，ALT升高组为58.6±24.7岁。根据超声扫描，患有脂肪肝的T2DM患者有117例（55.7%），非脂肪肝患者有93例（44.2%）。NAFLD患者的ALT显著更高（p<0.001），但血清天冬氨酸氨基转移酶（AST）、γ-谷氨酰转移酶（GGT）和碱性磷酸酶（ALP）水平无显著升高。仅基于ALT预测脂肪肝的受试者工作特征（AUROC）曲线下面积为0.84，置信区间（CI）为0.76至0.92（p<0.05）。结论 非酒精性脂肪性肝病在T2DM患者中高度流行。及时诊断和处理异常的肝脏参数可能有助于降低糖尿病患者肝脏相关的发病率和死亡率。
