Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China.
J Diabetes Investig. 2021 Jun;12(6):1035-1041. doi: 10.1111/jdi.13430. Epub 2021 Jan 8.
AIMS/INTRODUCTION: Non-alcoholic fatty liver disease, especially with liver fibrosis, is associated with cardiovascular diseases. The Non-Alcoholic Fatty Liver Disease Fibrosis Score (NFS), a non-invasive marker of advanced fibrosis, was found to be associated with cardiovascular diseases in different populations. The aim of the present study was to determine whether the NFS is associated with subclinical myocardial remodeling in type 2 diabetes patients.
A cross-sectional study was carried out in type 2 diabetes patients. The NFS derived from available parameters was calculated, and the participants were divided according to the quartiles of the NFS and grades of the NFS (low, intermediate and high). Fibrosis-4 and Aspartate Aminotransferase to Platelet Ratio Index, another two liver fibrosis scores, were also calculated. Subclinical myocardial remodeling was examined by echocardiography, and its associations with NFS, Fibrosis-4 and Aspartate Aminotransferase to Platelet Ratio Index were analyzed.
A total of 1,878 type 2 diabetes patients were enrolled in the present study. The NFS was independently associated with sex, age, body mass index, low-density lipoprotein cholesterol and glycated hemoglobin in type 2 diabetes patients. Parameters of subclinical myocardial remodeling including left atrial dimension, interventricular septum thickness, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left ventricular posterior wall thickness (LVPWT) and left ventricular mass index were all gradually increased with the increment of the NFS. Linear regression analysis further showed that the NFS was positively associated with left atrial dimension, interventricular septum thickness, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, LVPWT and left ventricular mass index after adjustment for the confounding factors. Similarly, Fibrosis-4 was associated with left atrial dimension, interventricular septum thickness, LVPWT and left ventricular mass index. In contrast, the Aspartate Aminotransferase to Platelet Ratio Index was only associated with LVPWT.
Non-invasive liver fibrosis scores, especially the NFS, are independently associated with subclinical myocardial remodeling in type 2 diabetes patients.
目的/引言：非酒精性脂肪性肝病，尤其是伴有肝纤维化的，与心血管疾病相关。非酒精性脂肪性肝病纤维化评分（NFS）是一种用于评估肝纤维化程度的无创标志物，它在不同人群中与心血管疾病相关。本研究旨在确定 NFS 是否与 2 型糖尿病患者的亚临床心肌重构有关。
本研究为一项横断面研究，纳入了 2 型糖尿病患者。计算了基于现有参数的 NFS，并根据 NFS 的四分位数和 NFS 分级（低、中、高）将参与者进行分组。还计算了纤维化-4 和天冬氨酸转氨酶血小板比值指数这两种其他的肝纤维化评分。通过超声心动图检查亚临床心肌重构，并分析 NFS、纤维化-4 和天冬氨酸转氨酶血小板比值指数与亚临床心肌重构的相关性。
本研究共纳入了 1878 例 2 型糖尿病患者。NFS 与性别、年龄、体重指数、低密度脂蛋白胆固醇和糖化血红蛋白在 2 型糖尿病患者中独立相关。包括左心房内径、室间隔厚度、左心室舒张末期直径、左心室收缩末期直径、左心室后壁厚度（LVPWT）和左心室质量指数在内的亚临床心肌重构参数均随 NFS 的增加而逐渐增加。线性回归分析进一步表明，在校正混杂因素后，NFS 与左心房内径、室间隔厚度、左心室舒张末期直径、左心室收缩末期直径、LVPWT 和左心室质量指数呈正相关。同样，纤维化-4 与左心房内径、室间隔厚度、LVPWT 和左心室质量指数相关。相反，天冬氨酸转氨酶血小板比值指数仅与 LVPWT 相关。
无创性肝纤维化评分，尤其是 NFS，与 2 型糖尿病患者的亚临床心肌重构独立相关。
