Afarideh Mohsen, Aryan Zahra, Ghajar Alireza, Ganji Morsaleh, Ghaemi Fatemeh, Saadat Mohammad, Heidari Behnam, Mechanick Jeffrey I, Esteghamati Alireza
Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Student's Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Prim Care Diabetes. 2019 Dec;13(6):505-514. doi: 10.1016/j.pcd.2019.03.009. Epub 2019 May 1.
Non-alcoholic fatty liver disease (NAFLD) affects risks of type 2 diabetes (T2D), diabetes-related complications, and cardiovascular disease in a complex manner. This study is designed to clarify associations of sonographically-detected NAFLD and serum liver enzymes with diabetes-related microvascular complications.
A matched case-contorl study was designed for 440 patients with T2D and at least one of the chronic diabetes-related microvascular complications and 495 age- and gender-matched control patients with T2D.
Considering pre-existing and newly developed chronic microvascular complications, diabetic peripheral neuropathy was found in 347 out of 935 (37.1%) study patients, diabetic retinopathy in 141/935 (15.1%), and diabetic nephropathy in 103/935 (11.0%). Diagnosis of diabetic retinopathy and diabetic nephropathy were inversely associated with the presence of NAFLD in the crude logistic regressions (OR [95% CI] = 0.18 [0.05-0.63], p value = 0.007; OR [95% CI] = 0.17 [0.04-0.59], p value = 0.011, respectively). The subgroup of NAFLD with elevated liver enzymes had lower odds of having diabetic peripheral neuropathy in the fully adjusted model (OR [95% CI] = 0.34 [0.12-0.98], p value = 0.048).
Diagnosis of NAFLD with or without elevated serum liver enzymes was inversely correlated with certain chronic diabetes microvascular complications. Possible explanations for this counter-intuitive and unexpected finding are discussed and center on reverse-causality, wherein sicker patients may develop beneficial compensatory physiological and behavioral adaptations. Diversity of studied patients, in particular with regards to the ethnic and racial differences among the Western and Asian populations may also partly account for contrasting findings of the relationship between NAFLD and microvascular complications of diabetes.
非酒精性脂肪性肝病（NAFLD）以复杂的方式影响2型糖尿病（T2D）、糖尿病相关并发症和心血管疾病的风险。本研究旨在阐明超声检测到的NAFLD和血清肝酶与糖尿病相关微血管并发症之间的关联。
针对440例患有T2D且至少有一种慢性糖尿病相关微血管并发症的患者以及495例年龄和性别匹配的T2D对照患者设计了一项匹配病例对照研究。
考虑到既往存在和新发生的慢性微血管并发症，935例研究患者中有347例（37.1%）患有糖尿病周围神经病变，141/935例（15.1%）患有糖尿病视网膜病变,103/935例（11.0%）患有糖尿病肾病。在粗逻辑回归中，糖尿病视网膜病变和糖尿病肾病的诊断与NAFLD的存在呈负相关（OR [95% CI] = 0.18 [0.05 - 0.63]，p值 = 0.007；OR [95% CI] = 0.17 [0.04 - 0.59]，p值 = 0.011）。在完全调整模型中，肝酶升高的NAFLD亚组患糖尿病周围神经病变的几率较低（OR [95% CI] = 0.34 [0.12 - 0.98]，p值 = 0.048）。
无论血清肝酶是否升高，NAFLD的诊断与某些慢性糖尿病微血管并发症呈负相关。讨论了这一违反直觉和意外发现的可能解释，其核心是反向因果关系，即病情较重的患者可能会产生有益的代偿性生理和行为适应。研究患者的多样性，特别是西方和亚洲人群之间的种族和民族差异，也可能部分解释了NAFLD与糖尿病微血管并发症之间关系的对比结果。
