Bellan Mattia, Colletta Cosimo, Barbaglia Matteo Nazzareno, Salmi Livia, Clerici Roberto, Mallela Venkata Ramana, Castello Luigi Mario, Saglietti Giuseppe, Carnevale Schianca Gian Piero, Minisini Rosalba, Pirisi Mario
Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.
Division of Internal Medicine, Sant'Andrea Hospital, Vercelli, Italy.
Diabetes Metab J. 2019 Oct;43(5):700-710. doi: 10.4093/dmj.2018.0201.
The prevalence of nonalcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM) is high, though its severity is often underestimated. Our aim is to provide an estimate of the prevalence of severe NAFLD in T2DM and identify its major predictors.
T2DM patients (=328) not previously known to have NAFLD underwent clinical assessment, transient elastography with measure of liver stiffness (LS) and controlled attenuation parameter (CAP), and genotyping for patatin like phospholipase domain containing 3 () and 17β-hydroxysteroid-dehydrogenase type 13 ().
Median LS was 6.1 kPa (4.9 to 8.6). More than one-fourth patients had advanced liver disease, defined as LS ≥7.9 kPa (=94/238, 29%), and had a higher body mass index (BMI) than those with a LS <7.9 kPa. Carriage of the G allele in the PNPLA3 gene was associated with higher LS, being 5.9 kPa (4.7 to 7.7) in C/C homozygotes, 6.1 kPa (5.2 to 8.7) in C/G heterozygotes, and 6.8 kPa (5.8 to 9.2) in G/G homozygotes (=0.01). This trend was absent in patients with ≥1 mutated allele. In a multiple linear regression model, BMI and genotype predicted LS, while age, gender, disease duration, and glycosylated hemoglobin did not fit into the model. None of these variables was confirmed to be predictive among carriers of at least one mutated allele. There was no association between CAP and polymorphisms of or .
Advanced NAFLD is common among T2DM patients. LS is predicted by both BMI and polymorphism, the effect of the latter being modulated by mutated .
2型糖尿病（T2DM）患者中非酒精性脂肪性肝病（NAFLD）的患病率很高，但其严重程度常常被低估。我们的目的是估计T2DM中重度NAFLD的患病率并确定其主要预测因素。
328例既往不知患有NAFLD的T2DM患者接受了临床评估、采用肝脏硬度（LS）和受控衰减参数（CAP）测量的瞬时弹性成像以及含patatin样磷脂酶结构域3（）和17β-羟类固醇脱氢酶13（）的基因分型。
LS中位数为6.1 kPa（4.9至8.6）。超过四分之一的患者患有晚期肝病，定义为LS≥7.9 kPa（=94/238，29%），且其体重指数（BMI）高于LS<7.9 kPa的患者。PNPLA3基因中G等位基因的携带与较高的LS相关，C/C纯合子中为5.9 kPa（4.7至7.7），C/G杂合子中为6.1 kPa（5.2至8.7），G/G纯合子中为6.8 kPa（5.8至9.2）（=0.01）。在≥1个突变等位基因的患者中未观察到这种趋势。在多元线性回归模型中，BMI和基因型可预测LS，而年龄、性别、病程和糖化血红蛋白不适合该模型。在至少携带1个突变等位基因的携带者中，这些变量均未被证实具有预测性。CAP与或的多态性之间无关联。
重度NAFLD在T2DM患者中很常见。LS可由BMI和多态性预测，后者的作用受突变调节。
