Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy.
Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.
Diabetes Care. 2021 Feb;44(2):519-525. doi: 10.2337/dc20-1778. Epub 2020 Dec 10.
Type 2 diabetes mellitus (T2DM) is an important risk factor for the progression of metabolic liver disease to advanced fibrosis. Here, we provide an estimate of the prevalence of steatosis and fibrosis in U.S. adults with T2DM on the basis of transient elastography (TE) and identify factors associated with these conditions.
This is a cross-sectional study of U.S. adults with T2DM participating in the 2017-2018 cycle of the National Health and Nutrition Examination Survey who were evaluated by TE. Hepatic steatosis and fibrosis were diagnosed by the median value of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), respectively.
Among the 825 patients with reliable TE examination results, 484 (53.7%) were assessed using the M probe and 341 (46.3%) using the XL probe. Liver steatosis (CAP ≥274 dB/m), advanced fibrosis (LSM ≥9.7 kPa), and cirrhosis (LSM ≥13.6 kPa) were present in 73.8% (95% CI 68.5%-78.5%), 15.4% (95% CI 12.2%-19.0%), and 7.7% (95% CI 4.8%-11.9%) of patients, respectively. The mean ± SE age of patients with advanced fibrosis and cirrhosis was 63.7 ± 2.2 years and 57.8 ± 1.6 years, respectively. In the multivariable logistic regression model, BMI, non-Black race, and ALT levels were independent predictors of steatosis; and BMI, non-Black race, and AST and γ-glutamyltranspeptidase levels were independent predictors of advanced fibrosis.
Prevalence of both liver steatosis and fibrosis is high in patients with T2DM from the United States and obesity is a major risk factor. Our results support the screening of these conditions among patients with diabetes.
2 型糖尿病（T2DM）是代谢性肝病进展为晚期纤维化的重要危险因素。在这里，我们根据瞬时弹性成像（TE）估计美国 T2DM 成年患者中脂肪变性和纤维化的患病率，并确定与这些情况相关的因素。
这是一项横断面研究，纳入了参加 2017-2018 年全国健康和营养调查（NHANES）周期的美国 T2DM 成年患者，他们接受了 TE 评估。通过受控衰减参数（CAP）和肝硬度测量值（LSM）的中位数分别诊断肝脂肪变性和纤维化。
在 825 例具有可靠 TE 检查结果的患者中，484 例（53.7%）使用 M 探头进行评估，341 例（46.3%）使用 XL 探头进行评估。肝脏脂肪变性（CAP≥274dB/m）、晚期纤维化（LSM≥9.7kPa）和肝硬化（LSM≥13.6kPa）分别存在于 73.8%（95%CI 68.5%-78.5%）、15.4%（95%CI 12.2%-19.0%）和 7.7%（95%CI 4.8%-11.9%）的患者中。晚期纤维化和肝硬化患者的平均年龄±SE 分别为 63.7±2.2 岁和 57.8±1.6 岁。在多变量逻辑回归模型中，BMI、非黑人种族和 ALT 水平是脂肪变性的独立预测因素；而 BMI、非黑人种族以及 AST 和γ-谷氨酰转肽酶水平是晚期纤维化的独立预测因素。
来自美国的 T2DM 患者中，肝脏脂肪变性和纤维化的患病率均较高，肥胖是主要危险因素。我们的研究结果支持对糖尿病患者进行这些疾病的筛查。
