Barros Bianca Senger Vasconcelos, Monteiro Fernanda Cruz, Terra Carlos, Gomes Marilia Brito
Department of Internal Medicine, Diabetes Unit, Pedro Ernesto Hospital, State University of Rio de Janeiro (UERJ), 20.551-030, Boulevard 28 de Setembro, 77 - 3º andar - Vila Isabel, Rio de Janeiro, RJ, CEP 20551-030, Brazil.
Department of Radiology, Pedro Ernesto Hospital, State University of Rio de Janeiro (UERJ), 20.551-030, Rio de Janeiro, RJ, Brazil.
Diabetol Metab Syndr. 2021 Mar 19;13(1):33. doi: 10.1186/s13098-021-00649-0.
Data on non-alcoholic fatty liver disease (NAFLD) in individuals with type 1 diabetes (T1D) is controversial and so far, there are no published data on the Brazilian population. We investigated the prevalence of steatosis and hepatic fibrosis in a population with T1D from a tertiary care center in Brazil and its associated factors.
Ninety-five participants with T1D, aged 39 ± 13 years, with disease duration of 21 ± 9 years, being 55 (57.9%) females, from a university hospital in Rio de Janeiro, were screened for NAFLD with hepatic ultrasound (US) and transient elastography (TE).
Prevalence of steatosis was, respectively, 12.6% and 16.8% when US and TE were used for diagnosis of NAFLD. Fibrosis was present in 8.4% of participants. A total of 31.6% of participants had at least one of the hepatic exams altered, which was associated with higher body mass index, waist circumference, hip circumference and waist-to-hip ratio,, presence of metabolic syndrome and higher triglycerides levels, even within the normal range. After multivariate analysis, presence of steatosis was only associated with metabolic syndrome and its component, triglycerides.
In our study, prevalence of NAFLD in ultrasound approximates the one found with TE. Fibrosis was not frequent. Screening should be reserved for participants with T1D and metabolic syndrome, as this was the main factor associated with NAFLD. Triglycerides levels were the only component of metabolic syndrome associated with steatosis. Further studies are necessary to determine the best screening strategy for NAFLD in individuals with T1D. Also, predisposing factors for development in fibrosis in T1D should be further explored in prospective studies.
1型糖尿病（T1D）患者中非酒精性脂肪性肝病（NAFLD）的数据存在争议，迄今为止，巴西人群中尚无相关发表数据。我们调查了巴西一家三级医疗中心的T1D患者人群中脂肪变性和肝纤维化的患病率及其相关因素。
对来自里约热内卢一家大学医院的95名T1D患者进行筛查，这些患者年龄为39±13岁，病程为21±9年，其中55名（57.9%）为女性，采用肝脏超声（US）和瞬时弹性成像（TE）对其进行NAFLD筛查。
当使用US和TE诊断NAFLD时，脂肪变性的患病率分别为12.6%和16.8%。8.4%的参与者存在纤维化。共有31.6%的参与者至少有一项肝脏检查结果异常，这与较高的体重指数、腰围、臀围和腰臀比、代谢综合征的存在以及较高的甘油三酯水平相关，即使甘油三酯水平在正常范围内。多因素分析后，脂肪变性仅与代谢综合征及其组分甘油三酯相关。
在我们的研究中，超声检查中NAFLD的患病率与TE检查结果相近。纤维化并不常见。应仅对患有T1D和代谢综合征的参与者进行筛查，因为这是与NAFLD相关的主要因素。甘油三酯水平是与脂肪变性相关的代谢综合征的唯一组分。有必要进行进一步研究以确定T1D患者中NAFLD的最佳筛查策略。此外，应在前瞻性研究中进一步探索T1D患者发生肝纤维化的易感因素。
