Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China.
Wujing Community Health Service Center, Shanghai, China.
J Diabetes Investig. 2021 Nov;12(11):2019-2027. doi: 10.1111/jdi.13562. Epub 2021 Aug 8.
AIMS/INTRODUCTION: Non-alcoholic fatty liver disease and type 2 diabetes mellitus are closely related, and often occur simultaneously in patients. Type 2 diabetes increases the risk of diabetic peripheral neuropathy, resulting in intolerable pain and extremity amputation that reduces the quality of life. However, the role of non-alcoholic fatty liver disease in the pathogenesis of diabetic peripheral neuropathy remains unclear. Thus, we evaluated the correlation of liver fibrosis and steatosis, which are representative histological morphologies of non-alcoholic fatty liver disease, with diabetic peripheral neuropathy in type 2 diabetes patients.
Five hundred twenty individuals with type 2 diabetes were recruited. All the patients were detected nerve conduction study for diabetic peripheral neuropathy and fibro touch for liver steatosis and fibrosis. Correlation of DPN with liver steatosis and fibrosis were analysed with binary logistic analysis.
Among the 520 patients, the prevalence of liver steatosis, fibrosis and diabetic peripheral neuropathy was 63.0% (n = 328), 18.1% (n = 94) and 52.1% (n = 271), respectively. The prevalence of diabetic peripheral neuropathy was significantly elevated in patients with liver steatosis (55.7 vs 44.9%, P = 0.03) and fibrosis (61.5 vs 50%, P = 0.04), and it increased as liver stiffness measurement increased. Additionally, both hepatic steatosis (odds ratio 1.48, 95% confidence interval 1.04-2.11, P = 0.03) and fibrosis (odds ratio 1.60, 95% confidence interval 1.02-2.51, P = 0.04) were correlated with diabetic peripheral neuropathy. After adjusting for age, sex, weight, height, body mass index, waist hip ratio, duration of type 2 diabetes, blood glucose, homeostatic model assessment of insulin resistance, blood pressure, serum lipid, liver enzyme, urea, uric acid, creatinine and inflammatory factors, liver fibrosis remained associated with diabetic peripheral neuropathy (odds ratio 2.24, 95% confidence interval 1.11-4.53, P = 0.02).
The prevalence of diabetic peripheral neuropathy was elevated in patients with liver steatosis and fibrosis. Liver fibrosis was also independently associated with an increased risk of diabetic peripheral neuropathy.
目的/引言：非酒精性脂肪性肝病与 2 型糖尿病密切相关，且常同时发生在患者身上。2 型糖尿病会增加发生糖尿病周围神经病变的风险，导致难以忍受的疼痛和四肢截肢，从而降低生活质量。然而，非酒精性脂肪性肝病在糖尿病周围神经病变发病机制中的作用尚不清楚。因此，我们评估了肝纤维化和脂肪变性（非酒精性脂肪性肝病的代表性组织学形态）与 2 型糖尿病患者糖尿病周围神经病变之间的相关性。
共招募了 520 名 2 型糖尿病患者。所有患者均接受神经传导研究以检测糖尿病周围神经病变，并接受 fibro touch 检查以检测肝脏脂肪变性和纤维化。采用二元逻辑分析分析 DPN 与肝脂肪变性和纤维化的相关性。
在 520 名患者中，肝脂肪变性、纤维化和糖尿病周围神经病变的患病率分别为 63.0%（n=328）、18.1%（n=94）和 52.1%（n=271）。肝脂肪变性（55.7%比 44.9%，P=0.03）和纤维化（61.5%比 50%，P=0.04）患者的糖尿病周围神经病变患病率显著升高，且随着肝硬度测量值的升高而增加。此外，肝脂肪变性（比值比 1.48，95%置信区间 1.04-2.11，P=0.03）和纤维化（比值比 1.60，95%置信区间 1.02-2.51，P=0.04）均与糖尿病周围神经病变相关。在调整年龄、性别、体重、身高、体重指数、腰臀比、2 型糖尿病病程、血糖、稳态模型评估的胰岛素抵抗、血压、血脂、肝酶、尿素、尿酸、肌酐和炎症因子后，肝纤维化仍与糖尿病周围神经病变相关（比值比 2.24，95%置信区间 1.11-4.53，P=0.02）。
肝脂肪变性和纤维化患者的糖尿病周围神经病变患病率升高。肝纤维化也与糖尿病周围神经病变风险增加独立相关。
