Ciardullo Stefano, Bianconi Eleonora, Zerbini Francesca, Perseghin Gianluca
Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy; Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.
Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy.
Diabetes Res Clin Pract. 2021 Jul;177:108879. doi: 10.1016/j.diabres.2021.108879. Epub 2021 May 29.
To investigate the relative contribution of previous gestational diabetes mellitus (GDM) and current type 2 diabetes (T2D) on the development of liver fibrosis, the strongest predictor of end-stage liver disease.
This is a population-based cross-sectional study based on data from the 2017-2018 cycle of the National Health and Nutrition Examination Survey. We included women age ≥ 20 years that had delivered at least one live birth and had available data on vibration-controlled transient elastography (VCTE). Liver steatosis and fibrosis were assessed by the median value of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), respectively.
Among the 1699 women included in the study, 144 (10.1%, 95% CI 7.7-13.2) reported a previous diagnosis of GDM. Women with previous GDM were younger, had a higher BMI, a higher prevalence of T2D and were significantly older at the time they had the last live birth. Univariate analysis did not show a significant difference between women with and without a prior history of GDM in terms of both steatosis (44.8% vs 39.4%, p = 0.464) and fibrosis (7.5% vs 7.6%, p = 0.854). Multivariable logistic regression analysis showed that BMI, γ-glutamyltranspeptidase levels, T2D (OR 2.96, 95% CI 1.48-5.93, p < 0.01), HBV and HCV infection were associated with higher odds of significant fibrosis, while previous GDM showed a neutral effect.
Women with previous GDM that do not develop overt T2D might not experience a poor hepatic prognosis.
探讨既往妊娠期糖尿病（GDM）和当前2型糖尿病（T2D）对肝纤维化发生发展的相对影响，肝纤维化是终末期肝病最强的预测指标。
这是一项基于人群的横断面研究，数据来自2017 - 2018年全国健康与营养检查调查周期。我们纳入了年龄≥20岁、至少生育过一次活产且有振动控制瞬时弹性成像（VCTE）可用数据的女性。分别通过控制衰减参数（CAP）的中位数和肝脏硬度测量（LSM）评估肝脏脂肪变性和纤维化。
在纳入研究的1699名女性中，144名（10.1%，95%CI 7.7 - 13.2）报告既往诊断为GDM。既往有GDM的女性更年轻，BMI更高，T2D患病率更高，且最后一次活产时年龄显著更大。单因素分析显示，有和无GDM病史的女性在脂肪变性（44.8%对39.4%，p = 0.464）和纤维化（7.5%对7.6%，p = 0.854）方面均无显著差异。多变量逻辑回归分析显示，BMI、γ-谷氨酰转肽酶水平、T2D（OR 2.96，95%CI 1.48 - 5.93，p < 0.01）、HBV和HCV感染与显著纤维化的较高几率相关，而既往GDM显示为中性效应。
既往有GDM但未发展为显性T2D的女性可能不会有不良的肝脏预后。
