Besutti Giulia, Bonilauri Lisa, Manicardi Elisa, Venturelli Francesco, Bonelli Efrem, Monelli Filippo, Manicardi Valeria, Valenti Luca, Ligabue Guido, Schianchi Susanna, Massari Marco, Riva Nicoletta, Froio Elisabetta, Tagliavini Elena, Pattacini Pierpaolo, Giorgi Rossi Paolo
Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
Diabetes Clinic, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Diabetes Res Clin Pract. 2021 Jul;177:108882. doi: 10.1016/j.diabres.2021.108882. Epub 2021 Jun 1.
We aimed to evaluate the feasibility and efficiency of a guidelines-compliant NAFLD assessment algorithm in patients with newly diagnosed type 2 diabetes (T2D).
Consecutive patients aged < 75 newly diagnosed with T2D without coexisting liver disease or excessive alcohol consumption were enrolled. Patients were stratified based on liver enzymes, fatty liver index, ultrasound, fibrosis scores and liver stiffness measurement. Referral rates and positive predictive values (PPVs) for histological non-alcoholic steatohepatitis (NASH) and significant fibrosis were evaluated.
Of the 171 enrolled patients (age 59 ± 10.2 years, 42.1% females), 115 (67.3%) were referred to a hepatologist due to abnormal liver enzymes (n = 60) or steatosis plus indeterminate (n = 37) or high NAFLD fibrosis score (n = 18). Liver biopsy was proposed to 30 patients (17.5%), but only 14 accepted, resulting in 12 NASH, one with significant fibrosis. The PPV of hepatological referral was 12/76 (15.8%) for NASH and 1/76 (1.3%) for NASH with significant fibrosis. The PPV of liver biopsy referral was 12/14 (85.7%) for NASH and 1/14 (7.1%) for NASH with significant fibrosis.
By applying a guidelines-compliant algorithm, many patients with T2D were referred for hepatological assessment and liver biopsy. Further studies are necessary to refine non-invasive algorithms.
我们旨在评估一种符合指南的非酒精性脂肪性肝病（NAFLD）评估算法在新诊断的2型糖尿病（T2D）患者中的可行性和效率。
纳入年龄<75岁、新诊断为T2D且无并存肝病或过量饮酒的连续患者。根据肝酶、脂肪肝指数、超声、纤维化评分和肝脏硬度测量对患者进行分层。评估组织学非酒精性脂肪性肝炎（NASH）和显著纤维化的转诊率及阳性预测值（PPV）。
在171例纳入患者中（年龄59±10.2岁，42.1%为女性），115例（67.3%）因肝酶异常（n = 60）、脂肪变性加不确定（n = 37）或高NAFLD纤维化评分（n = 18）被转诊至肝病专家处。30例患者（17.5%）被建议进行肝活检，但仅14例接受，其中12例诊断为NASH，1例有显著纤维化。肝病转诊对于NASH的PPV为12/76（15.8%），对于有显著纤维化的NASH为1/76（1.3%）。肝活检转诊对于NASH的PPV为12/14（85.7%），对于有显著纤维化的NASH为1/14（7.1%）。
通过应用符合指南的算法，许多T2D患者被转诊进行肝病评估和肝活检。需要进一步研究以完善非侵入性算法。
