Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.
Arch Iran Med. 2021 Mar 1;24(3):177-186. doi: 10.34172/aim.2021.28.
Non-alcoholic fatty liver disease (NAFLD) is common in people with type 2 diabetes mellitus (T2DM). We aimed to explore predictive factors of NAFLD in T2DM and identify high risk subgroups.
This was a cross-sectional study including 100 individuals with T2DM and 100 without diabetes matched for age, sex, and body mass index (BMI). Hepatic steatosis grades (calculated by controlled attenuation parameters-CAP score-3), and liver fibrosis stages (F0-F4) were determined using transient elastography.
The frequency of NAFLD was comparable between the two study groups. However, CAP scores were significantly higher in individuals with diabetes (294.90 ± 53.12 vs. 269.78 ± 45.05 dB/m; < 0.001). Fifty percent of individuals with diabetes had severe steatosis (S3), while this figure was 31.6% in those without diabetes ( < 0.05). Significant fibrosis (F2-F4) was more frequent in individuals with T2DM (13% vs. 4.1%, = 0.02). Individuals with T2DM and advanced fibrosis had significantly higher BMI, waist circumference (WC), waist-hip ratio (WHR), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and CAP score compared to those without fibrosis ( < 0.05). In the regression analysis, a model including BMI, WHR, AST and female gender explained 50% of the variation in CAP score in patients with diabetes (all < 0.05, adjusted R : 0.508). CAP scores were also the major determinant of liver fibrosis in this group (OR: 1.04; CI: 1.017-1.063; = 0.001).
Individuals with diabetes are more likely to have severe fibrosis. Obesity (especially central obesity), the female gender, elevated liver enzymes, and higher degree of insulin resistance are associated with more advanced liver disease in individuals with T2DM.
非酒精性脂肪性肝病（NAFLD）在 2 型糖尿病（T2DM）患者中较为常见。本研究旨在探讨 T2DM 患者发生 NAFLD 的预测因素，并确定高危亚组。
这是一项横断面研究，共纳入 100 例 T2DM 患者和 100 例年龄、性别和体重指数（BMI）相匹配的非糖尿病患者。采用瞬时弹性成像技术检测肝脂肪变性程度（通过受控衰减参数-CAP 评分-3 计算）和肝纤维化分期（F0-F4）。
两组患者 NAFLD 的发生率相当。然而，糖尿病组的 CAP 评分明显更高（294.90±53.12 vs. 269.78±45.05 dB/m；<0.001）。50%的糖尿病患者存在严重脂肪变性（S3），而非糖尿病患者这一比例为 31.6%（<0.05）。T2DM 患者中显著纤维化（F2-F4）更为常见（13% vs. 4.1%，=0.02）。与无纤维化患者相比，合并纤维化的 T2DM 患者的 BMI、腰围（WC）、腰臀比（WHR）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）和 CAP 评分明显更高（<0.05）。在回归分析中，包括 BMI、WHR、AST 和女性性别在内的模型可以解释糖尿病患者中 CAP 评分变化的 50%（均<0.05，调整 R2：0.508）。CAP 评分也是该组患者肝纤维化的主要决定因素（OR：1.04；95%CI：1.017-1.063；=0.001）。
糖尿病患者更易发生严重纤维化。肥胖（尤其是中心性肥胖）、女性、肝酶升高和更高程度的胰岛素抵抗与 T2DM 患者更严重的肝病有关。
