Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia.
Department of Gastroenterology and Hepatology, University Hospital Centre Tuzla, Tuzla, Bosnia and Herzegovina.
Can J Gastroenterol Hepatol. 2021 Mar 8;2021:5582813. doi: 10.1155/2021/5582813. eCollection 2021.
To investigate morbidity and mortality in a real-life cohort of patients with type 2 diabetes (T2D) in relation to prevalence and severity of nonalcoholic fatty liver disease (NAFLD).
Patients with T2D were referred for assessment of liver fibrosis by the FIB-4 test and liver stiffness measurement (LSM) by vibration-controlled transient elastography (VCTE). Liver steatosis was quantified by the controlled attenuation parameter (CAP). These patients were followed until death or censored date.
Among 454 patients (52% males, mean age 62.5 years, BMI 30.9 kg/m), 82.6% was overweight, 77.8% had fatty liver, and 9.9% and 3.1% had LSM and FIB-4 values suggestive of advanced fibrosis, respectively. During the follow-up period of median 2 years, 106 (23%) patients experienced adverse event (11% cardiovascular) and 17 (3.7%) died, whereas no liver-related morbidity or mortality was observed. Independent predictors of adverse outcomes were age and higher platelet count, while FIB-4, LSM, and CAP were not.
In a cohort of T2D patients, no liver-related morbidity or mortality occurred during 2 years. Our patients probably have low real prevalence of advanced fibrosis which is likely overestimated by LSM ≥ 9.6 kPa. Liver fibrosis may be safely reassessed in the 2 years interval in noncirrhotic patients with T2D.
研究与非酒精性脂肪性肝病（NAFLD）的患病率和严重程度相关的 2 型糖尿病（T2D）患者的发病率和死亡率。
将 T2D 患者转介进行肝纤维化评估，方法是通过 FIB-4 试验和振动控制瞬态弹性成像（VCTE）进行肝硬度测量（LSM）。通过受控衰减参数（CAP）定量评估肝脂肪变性。这些患者被随访至死亡或截止日期。
在 454 名患者（52%为男性，平均年龄 62.5 岁，BMI 为 30.9kg/m²）中，82.6%超重，77.8%有脂肪肝，9.9%和 3.1%的 LSM 和 FIB-4 值提示存在晚期纤维化。在中位随访 2 年期间，106 名（23%）患者发生不良事件（11%为心血管事件），17 名（3.7%）死亡，而无肝脏相关发病率或死亡率。不良结局的独立预测因素是年龄和血小板计数较高，而 FIB-4、LSM 和 CAP 则不是。
在 T2D 患者队列中，2 年内未发生与肝脏相关的发病率或死亡率。我们的患者可能具有较低的真实晚期纤维化患病率，这可能被 LSM≥9.6kPa 高估了。在非肝硬化 T2D 患者中，2 年内可安全重新评估肝纤维化。
