Division of Experimental Medicine, McGill University, Montreal, QC, Canada.
Division of Gastroenterology and Hepatology, University Health Network Toronto, Toronto General Hospital, Toronto, ON, Canada.
J Diabetes Complications. 2021 Sep;35(9):107978. doi: 10.1016/j.jdiacomp.2021.107978. Epub 2021 Jun 19.
Liver disease has emerged as a significant cause of death in people with type 2 diabetes (T2D). Due to a common underlying pathogenic mechanism, namely insulin resistance, T2D represents the main risk factor for nonalcoholic fatty liver disease (NAFLD), characterized by a buildup of fat in the liver. Globally, NAFLD is the most common liver disease, affecting a quarter of the general adult population. The development of nonalcoholic steatohepatitis (NASH) signifies an increased risk of liver fibrosis progression that can result in cirrhosis, hepatocellular carcinoma (HCC), and death. Liver fibrosis progression and development of cirrhosis is mostly asymptomatic until complications from decompensated end-stage liver disease arise. Traditionally, liver biopsy is used to diagnose NASH and stage fibrosis, however, it is invasive and costly. Non-invasive diagnostic alternatives include serum biomarkers and imaging techniques. Early identification of advanced liver fibrosis is pivotal to prompt initiation of targeted surveillance, including screening for HCC, as well as providing options for current and investigational therapeutic interventions to reduce fibrosis progression. This review gives an update on non-invasive diagnostic tools for NAFLD and liver fibrosis in the specific context of T2D, providing clinicians a pragmatic diagnostic approach to this frequent comorbidity in diabetes medicine.
肝脏疾病已成为 2 型糖尿病（T2D）患者死亡的重要原因。由于存在胰岛素抵抗这一共同的潜在发病机制，T2D 成为非酒精性脂肪性肝病（NAFLD）的主要危险因素，其特征是肝脏脂肪堆积。在全球范围内，NAFLD 是最常见的肝脏疾病，影响四分之一的普通成年人群。非酒精性脂肪性肝炎（NASH）的发展意味着肝纤维化进展的风险增加，可能导致肝硬化、肝细胞癌（HCC）和死亡。肝纤维化进展和肝硬化的发展在出现失代偿终末期肝病的并发症之前大多无症状。传统上，肝活检用于诊断 NASH 和纤维化分期，但它具有侵袭性且昂贵。非侵入性诊断替代方法包括血清生物标志物和成像技术。早期识别晚期肝纤维化对于及时开始靶向监测至关重要，包括筛查 HCC，并为当前和正在研究的治疗干预措施提供选择，以减少纤维化进展。本综述更新了 T2D 特定背景下用于 NAFLD 和肝纤维化的非侵入性诊断工具，为临床医生提供了一种实用的诊断方法来处理糖尿病医学中这种常见的合并症。
