Lombardi Rosa, Airaghi Lorena, Targher Giovanni, Serviddio Gaetano, Maffi Gabriele, Mantovani Alessandro, Maffeis Claudio, Colecchia Antonio, Villani Rosanna, Rinaldi Luca, Orsi Emanuela, Pisano Giuseppina, Adinolfi Luigi E, Fargion Silvia, Fracanzani Anna L
Department of Pathophysiology and Transplantation, Ca' Granda IRCCS Foundation, Policlinico Hospital, University of Milan, Milan, Italy.
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University Hospital of Verona, Verona, Italy.
Liver Int. 2020 Feb;40(2):347-354. doi: 10.1111/liv.14274. Epub 2019 Oct 31.
BACKGROUND & AIMS: Non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) are closely associated, and liver fibrosis has been related to macrovascular complications. We examined whether liver fibrosis, diagnosed by FibroScan , correlates with chronic vascular complications in a cohort of T2DM.
We recruited 394 outpatients with T2DM attending five Italian diabetes centres who underwent liver ultrasonography (US), FibroScan and extensive evaluation of macrovascular and microvascular diabetic complications.
Steatosis by US was present in 89%. Almost all patients (96%) were on hypoglycaemic drugs, 58% had at least one chronic vascular complication, 19% a macrovascular complication (prior myocardial infarction and/or ischaemic stroke) and 33% a microvascular one (26% chronic kidney disease [CKD]; 16% retinopathy; 6% neuropathy). In all, 171 (72%) patients had CAP ≥ 248dB/m (ie hepatic steatosis), whereas 83 (21%) patients had LSM ≥ 7.0/6.2 kPa (M/XL probes) (significant liver fibrosis). CAP was not associated with any macro/microvascular complications, whereas LSM ≥ 7.0/6.2 kPa was independently associated with prior cardiovascular disease (adjusted OR 3.3, 95%CI 1.2-8.8; P = .02) and presence of microvascular complications (adjusted OR 4.2, 95%CI 1.5-11.4; P = .005), mainly CKD (adjusted OR 3.6, 95%CI 1.3-10.1; P = .01) and retinopathy (adjusted OR 3.7, CI 95% 1.2-11.9; P = .02). Neither diabetes duration nor haemoglobin A1c differed according to CAP or LSM values.
Significant fibrosis, detected by FibroScan , is independently associated with increased prevalence of macrovascular and microvascular complications, thus opening a new scenario in the use of this tool for a comprehensive evaluation of hepatic and vascular complications in patients with T2DM.
非酒精性脂肪性肝病（NAFLD）与2型糖尿病（T2DM）密切相关，且肝纤维化与大血管并发症有关。我们研究了通过FibroScan诊断的肝纤维化是否与一组T2DM患者的慢性血管并发症相关。
我们招募了来自五个意大利糖尿病中心的394例T2DM门诊患者，这些患者接受了肝脏超声检查（US）、FibroScan检查以及对大血管和微血管糖尿病并发症的广泛评估。
超声检查显示89%的患者存在脂肪变性。几乎所有患者（96%）正在使用降糖药物，58%的患者至少有一种慢性血管并发症，19%的患者有大血管并发症（既往心肌梗死和/或缺血性中风），33%的患者有微血管并发症（26%为慢性肾脏病[CKD]；16%为视网膜病变；6%为神经病变）。共有171例（72%）患者的受控衰减参数（CAP）≥248dB/m（即肝脏脂肪变性），而83例（21%）患者的肝脏硬度值（LSM）≥7.0/6.2kPa（M/XL探头）（显著肝纤维化）。CAP与任何大/微血管并发症均无关联，而LSM≥7.0/6.2kPa与既往心血管疾病独立相关（校正比值比3.3，95%置信区间1.2 - 8.8；P = 0.02）以及微血管并发症的存在相关（校正比值比4.2，95%置信区间1.5 - 11.4；P = 0.005），主要是CKD（校正比值比3.6，95%置信区间1.3 - 10.1；P = 0.01）和视网膜病变（校正比值比3.7，95%置信区间1.2 - 11.9；P = 0.02）。糖尿病病程和糖化血红蛋白水平在不同CAP或LSM值的患者中并无差异。
通过FibroScan检测到的显著纤维化与大血管和微血管并发症的患病率增加独立相关，从而为使用该工具全面评估T2DM患者的肝脏和血管并发症开辟了新的前景。
