Tuong Tran Thi Khanh, Tran Dang Khoa, Phu Pham Quang Thien, Hong Tong Nguyen Diem, Dinh Thien Chu, Chu Dinh Toi
Department of Internal Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City 700000, Vietnam.
. Department of Anatomy, Pham Ngoc Thach University of Medicine (PNTU), Ho Chi Minh City 700000, Vietnam.
Diagnostics (Basel). 2020 Mar 14;10(3):159. doi: 10.3390/diagnostics10030159.
Patients with type 2 diabetes mellitus (T2DM) are at increased risk of non-alcoholic fatty liver disease (NAFLD) and might eventually progress to advanced fibrosis, cirrhosis and hepatocellular carcinoma (HCC). Recommendations on whether to screen for NAFLD in diabetic patients remains conflicted between major guidelines. Transient elastography using FibroScan with CAP (controlled attenuation parameter) can assess both liver steatosis and fibrosis simultaneously. This paper took a new look at the prevalence of NAFLD and the severity of fibrosis among T2DM patients in Vietnam. The study was conducted using a cross-sectional design in T2DM adults who attended Dai Phuoc Ho Chi Minh Polyclinic and Polyclinic of Pham Ngoc Thach University of Medicine. Liver steatosis and fibrosis was assessed by FibroScan. NAFLD was diagnosed if CAP > 233 dB/m (steatosis > 5%). Data were analyzed using STATA 12 software program. We found that a total of 307 type 2 diabetic patients qualified for the study's criteria. The prevalence of NAFLD in T2DM patients based on FibroScan was 73.3%. Rates of mild, moderate and severe steatosis were 20.5%, 21.8% and 30.9%, respectively. The prevalence of significant fibrosis (≥ F2), advanced fibrosis (≥ F3) and cirrhosis (F4) was 13.0%, 5.9% and 3.6%, respectively. On multivariate analysis, aspartate aminotransferase (AST) (OR: 1.067; 95% CI: 1.017-1.119; p = 0.008) and platelet levels (OR: 0.985; 95% CI: 0.972-0.999; p = 0.034) were independent of risk factors of advanced fibrosis. Thus, our study supports screening for NAFLD and for evaluating the severity of liver fibrosis in T2DM patients.
2型糖尿病（T2DM）患者患非酒精性脂肪性肝病（NAFLD）的风险增加，最终可能进展为晚期纤维化、肝硬化和肝细胞癌（HCC）。主要指南对于是否对糖尿病患者进行NAFLD筛查的建议仍存在分歧。使用配备受控衰减参数（CAP）的FibroScan进行瞬时弹性成像可以同时评估肝脏脂肪变性和纤维化。本文重新审视了越南T2DM患者中NAFLD的患病率和纤维化的严重程度。该研究采用横断面设计，对就诊于胡志明市戴福综合诊所和范五老医科大学综合诊所的成年T2DM患者进行。通过FibroScan评估肝脏脂肪变性和纤维化。如果CAP>233 dB/m（脂肪变性>5%）则诊断为NAFLD。使用STATA 12软件程序分析数据。我们发现共有307例2型糖尿病患者符合研究标准。基于FibroScan的T2DM患者中NAFLD的患病率为73.3%。轻度、中度和重度脂肪变性的发生率分别为20.5%、21.8%和30.9%。显著纤维化（≥F2）、晚期纤维化（≥F3）和肝硬化（F4）的患病率分别为13.0%、5.9%和3.6%。多因素分析显示，天冬氨酸转氨酶（AST）（比值比：1.067；95%置信区间：1.017 - 1.119；p = 0.008）和血小板水平（比值比：0.985；95%置信区间：0.972 - 0.999；p = 0.034）是晚期纤维化的独立危险因素。因此，我们的研究支持对T2DM患者进行NAFLD筛查和评估肝脏纤维化的严重程度
