Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
Diabetes Metab Res Rev. 2020 Jul;36(5):e3294. doi: 10.1002/dmrr.3294. Epub 2020 Feb 17.
Kidney dysfunction is linked to nonalcoholic fatty liver disease (NAFLD) progression including fibrosis, steatosis, or inflammation. We aimed to explore whether lower levels of estimated glomerular filtration rate (eGFR) was associated with increased probability of liver fibrosis.
Two thousand six hundred eighty-nine subjects enrolled from Shanghai, China, were included in this study. NAFLD fibrosis score (NFS) was used to risk stratify NAFLD patients for fibrosis. eGFR was used to assess kidney function. The association of eGFR level with elevated NFS, and thus high risk of fibrosis, was analysed by linear regression and multinomial logistic regression. The predictive power of eGFR was evaluated via receiver operating characteristic (ROC) curve.
A negative association was found between eGFR and NFS (B = -0.21, 95% CI, -0.37 to -0.04, P = .016). As eGFR quartiles decreased, the prevalence of probable fibrosis increased after adjusting for age, sex, current smoking, waist circumference, duration of diabetes, HbA , hypertension, dyslipidaemia, and homeostasis model assessment index of insulin resistance (HOMA-IR) (Q4: reference; Q3: 1.49, 95% CI, 0.82-2.71; Q2: 1.88, 95% CI, 0.97-3.67; Q1: 2.70, 95% CI, 1.36-5.37, P = .002, 1SD increment: 0.73, 95% CI, 0.58-0.92). The eGFR level can be an effective indicator in differentiating patients with probable presence of fibrosis from those without (AUROC: 0.71, cut-off point: 92.78 mL/min/1.73 m , P < .001).
Lower levels of eGFR were associated with higher NFS and thus greater risk of presence of fibrosis in patients with NAFLD and T2DM. Individuals with NAFLD and diabetes should carefully monitor eGFR and receive regular urinalysis, especially when advanced fibrosis is suspected.
肾功能障碍与非酒精性脂肪性肝病（NAFLD）的进展有关，包括纤维化、脂肪变性或炎症。我们旨在探讨估算肾小球滤过率（eGFR）水平降低是否与肝纤维化概率增加相关。
本研究纳入了来自中国上海的 2689 名受试者。使用 NAFLD 纤维化评分（NFS）对 NAFLD 患者进行纤维化风险分层。eGFR 用于评估肾功能。通过线性回归和多项逻辑回归分析 eGFR 水平与升高的 NFS（即纤维化高风险）之间的关联。通过接收者操作特征（ROC）曲线评估 eGFR 的预测能力。
eGFR 与 NFS 呈负相关（B=-0.21，95%CI，-0.37 至-0.04，P=0.016）。在校正年龄、性别、当前吸烟状况、腰围、糖尿病病程、糖化血红蛋白（HbA1c）、高血压、血脂异常和胰岛素抵抗稳态模型评估指数（HOMA-IR）后，随着 eGFR 四分位数降低，可能存在纤维化的患病率增加（Q4：参考；Q3：1.49，95%CI，0.82-2.71；Q2：1.88，95%CI，0.97-3.67；Q1：2.70，95%CI，1.36-5.37，P=0.002，1SD 增量：0.73，95%CI，0.58-0.92）。eGFR 水平可有效区分存在或不存在纤维化的患者（AUROC：0.71，临界值：92.78 mL/min/1.73 m，P<0.001）。
eGFR 水平降低与 NFS 升高相关，因此患有非酒精性脂肪性肝病和 2 型糖尿病的患者存在纤维化的风险更高。患有非酒精性脂肪性肝病和糖尿病的个体应密切监测 eGFR 并定期进行尿检，特别是在怀疑存在晚期纤维化时。
