骨骼肌量低与 2 型糖尿病和非酒精性脂肪性肝病患者的肝纤维化有关。
Low skeletal muscle mass is associated with liver fibrosis in individuals with type 2 diabetes and nonalcoholic fatty liver disease.
机构信息
Division of Endocrinology and Diabetes, Medanta The Medicity Hospital, Gurugram, India.
Division of Hepatology, Medanta The Medicity Hospital, Gurugram, India.
出版信息
J Gastroenterol Hepatol. 2021 Nov;36(11):3204-3211. doi: 10.1111/jgh.15595. Epub 2021 Jul 6.
BACKGROUND AND AIM
Type 2 diabetes (T2D) and low skeletal muscle mass (SMM) are associated with increased risk of nonalcoholic fatty liver disease (NAFLD). However, data regarding the association between low SMM and NAFLD-related liver fibrosis in individuals with T2D are scarce. Therefore, we aimed to investigate the association between low SMM and liver fibrosis in individuals with T2D and NAFLD.
METHODS
Controlled attenuation parameter (CAP) of ≥ 248 dB/m was taken as cutoff suggesting NAFLD. Clinically relevant liver fibrosis and advanced liver fibrosis were defined as liver stiffness measurement (LSM) by transient elastography (TE) of ≥ 8.0 and ≥ 9.6 kPa, respectively. SMM was measured using dual energy X-ray absorptiometry (DEXA). Low SMM was defined as appendicular SMM index of < 7.0 kg/m for men and < 5.4 kg/m for women.
RESULTS
Of the 487 consecutive patients with T2D, 366 (75.1%) had NAFLD. Among individuals with NAFLD, 118 (32.2%) and 64 (17.5%) had clinically relevant liver fibrosis and advanced liver fibrosis, respectively. Low SMM was diagnosed in 78 (21.3%) individuals with NAFLD. Patients with low SMM were older (56.1 vs 52.8 years) and had longer duration of diabetes (10.3 vs 8.1 years). Low SMM was an independent risk factor associated with clinically relevant liver fibrosis (P = 0.002) and advanced liver fibrosis (P ≤ 0.0001). Associations between low SMM and clinically relevant- and advanced liver fibrosis were maintained even after sequential adjustment for confounding variables through the multivariate regression analysis.
CONCLUSIONS
Low SMM is independently associated with liver fibrosis in individuals with T2D and NAFLD.
背景与目的
2 型糖尿病（T2D）和低骨骼肌量（SMM）与非酒精性脂肪性肝病（NAFLD）的风险增加相关。然而，关于 T2D 患者低 SMM 与 NAFLD 相关肝纤维化之间关系的数据却很少。因此，我们旨在研究 T2D 和 NAFLD 患者中低 SMM 与肝纤维化之间的关系。
方法
采用控制衰减参数（CAP）≥248dB/m 作为 NAFLD 的截断值。通过瞬时弹性成像（TE）测量的肝硬度值（LSM）≥8.0kPa 和≥9.6kPa 分别定义为临床显著肝纤维化和晚期肝纤维化。使用双能 X 射线吸收法（DEXA）测量 SMM。低 SMM 定义为男性四肢骨骼肌指数＜7.0kg/m，女性＜5.4kg/m。
结果
在 487 例连续的 T2D 患者中，366 例（75.1%）患有 NAFLD。在患有 NAFLD 的患者中，118 例（32.2%）和 64 例（17.5%）分别患有临床显著肝纤维化和晚期肝纤维化。在患有 NAFLD 的患者中，有 78 例（21.3%）被诊断为低 SMM。低 SMM 患者年龄更大（56.1 岁比 52.8 岁），糖尿病病程更长（10.3 年比 8.1 年）。低 SMM 是与临床显著肝纤维化（P=0.002）和晚期肝纤维化（P≤0.0001）相关的独立危险因素。即使通过多元回归分析对混杂变量进行逐步调整后，低 SMM 与临床显著肝纤维化和晚期肝纤维化之间的关系仍然存在。
结论
低 SMM 与 T2D 和 NAFLD 患者的肝纤维化独立相关。
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