二甲双胍治疗 2 年后 2 型糖尿病患者肝纤维化和脂肪变性标志物的演变。
Evolution of liver fibrosis and steatosis markers in patients with type 2 diabetes after metformin treatment for 2 years.
机构信息
Department of Internal medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea; Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea.
Department of Internal medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea; Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea.
出版信息
J Diabetes Complications. 2021 Jan;35(1):107747. doi: 10.1016/j.jdiacomp.2020.107747. Epub 2020 Oct 9.
BACKGROUND/AIMS: Type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD) share pathophysiological mechanism. Metformin is a widely used first-line anti-diabetic drug. We investigated the evolution of liver fibrosis and steatosis during 2-year use of metformin in patients with T2DM.
METHODS
Between 2006 and August 2010, patients newly diagnosed with T2DM who received metformin as the first-line treatment were recruited. Fibrosis-4 index (FIB-4) > 2.67 and hepatic steatosis index (HSI) > 36.0 was used to define advanced liver fibrosis and fatty liver, respectively.
RESULTS
A total of 1292 (mean age 60.8 years, 57% men and 43% women) patients were recruited. The mean FIB-4 and HSI scores were 1.38 and 27.3, respectively. At enrollment, 83 (6.4%) patients had advanced liver fibrosis and 429 (33.2%) had fatty liver. After 2 years of metformin treatment, the mean FIB-4 score increased from 1.38 to 1.51 (p < 0.001), whereas the mean HSI score decreased from 27.3 to 26.5 (p < 0.001). During follow-up, advanced liver fibrosis additionally developed in 52/1209 (4.3%) patients, whereas 48/83 (57.8%) experienced fibrosis regression. Older age (odds ratio [OR] = 1.007), lower platelet count (OR = 0.993), and lower serum albumin (OR = 0.325) were independently associated with the increased risk of advanced liver fibrosis development after 2-years of metformin treatment.
CONCLUSION
In our cohort of patients with metformin treatment, a small proportion of patients developed liver fibrosis and steatosis after 2 years. Optimized follow-up strategy is required according to different risk of liver fibrosis progression in patients with T2DM.
背景/目的：2 型糖尿病（T2DM）和非酒精性脂肪性肝病（NAFLD）具有共同的病理生理机制。二甲双胍是一种广泛应用的一线抗糖尿病药物。我们研究了在 T2DM 患者使用二甲双胍 2 年期间肝纤维化和脂肪变性的演变。
方法
在 2006 年至 2010 年 8 月期间，招募了新诊断为 T2DM 并接受二甲双胍作为一线治疗的患者。纤维化 4 指数（FIB-4）>2.67 和肝脂肪变性指数（HSI）>36.0 分别用于定义晚期肝纤维化和脂肪肝。
结果
共招募了 1292 名（平均年龄 60.8 岁，57%为男性，43%为女性）患者。平均 FIB-4 和 HSI 评分分别为 1.38 和 27.3。入组时，83 名（6.4%）患者有晚期肝纤维化，429 名（33.2%）有脂肪肝。在接受二甲双胍治疗 2 年后，平均 FIB-4 评分从 1.38 增加到 1.51（p<0.001），而平均 HSI 评分从 27.3 降低到 26.5（p<0.001）。在随访期间，52/1209（4.3%）名患者的晚期肝纤维化进一步发展，而 48/83（57.8%）名患者的纤维化发生了逆转。年龄较大（比值比 [OR] = 1.007）、血小板计数较低（OR = 0.993）和血清白蛋白较低（OR = 0.325）与二甲双胍治疗 2 年后晚期肝纤维化发展的风险增加独立相关。
结论
在我们的二甲双胍治疗患者队列中，少数患者在 2 年后出现肝纤维化和脂肪变性。需要根据 T2DM 患者的肝纤维化进展风险制定优化的随访策略。
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