Grecian Sheila M, McLachlan Stela, Fallowfield Jonathan A, Hayes Peter C, Guha Indra Neil, Morling Joanne R, Glancy Stephen, Williamson Rachel M, Reynolds Rebecca M, Frier Brian M, Zammitt Nicola N, Price Jackie F, Strachan Mark W J
Usher Institute of Population Health Sciences and Informatics University of Edinburgh Edinburgh UK.
Centre for Inflammation Research Queen's Medical Research Institute University of Edinburgh Edinburgh UK.
Obes Sci Pract. 2021 May 6;7(5):497-508. doi: 10.1002/osp4.484. eCollection 2021 Oct.
Type 2 diabetes (T2D) is associated with increased risk of progression to cirrhosis and hepatocellular carcinoma (HCC) in people with chronic liver diseases, particularly non-alcoholic fatty liver disease (NAFLD). However, the absolute risk of progression is low. So, it is crucial to accurately identify patients who would benefit most from hepatology referral and intensified management. Current risk-stratification tools are suboptimal and perform worse in people with diabetes.
To determine whether the addition of complementary biomarker(s) to current NAFLD risk-stratification tools in people with T2D could improve the identification of people who are at increased risk of developing incident cirrhosis or HCC.
The Edinburgh Type 2 diabetes Study (ET2DS) is a cohort study of men and women with T2D ( = 1066, age 60-75 at baseline). Cases of cirrhosis and HCC were identified over 11 years of follow-up. Biomarkers were measured at baseline and year 1 and association with incident disease was assessed using logistic regression.
Of existing risk-stratification scores tested, the Fibrosis-4 (FIB-4) index and the AST:platelet ratio index (APRI) performed best in this cohort. Addition of hyaluronic acid (cut-point ≥ 50 g/L) to FIB-4 (cut-point ≥ 1.3) maintained a false negative rate of ≤25% and reduced the number of people incorrectly identified as "high risk" for incident disease by ∼50%.
The addition of hyaluronic acid to FIB-4 reduced the proportion of people inappropriately identified as "high risk" for development of cirrhosis/HCC in a community population of otherwise asymptomatic people with T2D. These findings require a validation in independent cohorts.
2型糖尿病（T2D）与慢性肝病患者，尤其是非酒精性脂肪性肝病（NAFLD）患者进展为肝硬化和肝细胞癌（HCC）的风险增加相关。然而，进展的绝对风险较低。因此，准确识别最能从肝病转诊和强化管理中获益的患者至关重要。目前的风险分层工具并不理想，在糖尿病患者中表现更差。
确定在T2D患者中，在当前NAFLD风险分层工具中添加补充生物标志物是否能改善对发生肝硬化或HCC风险增加的患者的识别。
爱丁堡2型糖尿病研究（ET2DS）是一项对T2D男性和女性（n = 1066，基线年龄60 - 75岁）的队列研究。在11年的随访中识别出肝硬化和HCC病例。在基线和第1年测量生物标志物，并使用逻辑回归评估与新发疾病的关联。
在所测试的现有风险分层评分中，纤维化-4（FIB-4）指数和AST：血小板比率指数（APRI）在该队列中表现最佳。在FIB-4（切点≥1.3）中添加透明质酸（切点≥50 μg/L）可使假阴性率≤25%，并将被错误识别为新发疾病“高风险”的人数减少约50%。
在FIB-4中添加透明质酸可降低在无症状T2D社区人群中被不恰当地识别为肝硬化/HCC发生“高风险”的人群比例。这些发现需要在独立队列中进行验证。
