1型糖尿病患者中非酒精性脂肪性肝病（NAFLD）的患病率及其与胰岛素抵抗替代指标的关联。
Prevalence of non-alcoholic fatty liver disease (NAFLD) and its association with surrogate markers of insulin resistance in patients with type 1 diabetes.
作者信息
de Vries Marieke, Westerink Jan, El-Morabit Fatima, Kaasjager H A H Karin, de Valk Harold W
机构信息
Department of Internal Medicine, Diabetology and Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Gastroenterology, University Medical Center Utrecht, Utrecht, the Netherlands.
出版信息
Diabetes Res Clin Pract. 2022 Apr;186:109827. doi: 10.1016/j.diabres.2022.109827. Epub 2022 Mar 10.
AIMS
Assess prevalence of hepatic steatosis (HS) and of fibrosis in an unselected population of patients with type 1 diabetes. Describe their clinical profile and explore the association between insulin resistance and NAFLD as secondary objectives.
METHODS
We prospectively assessed NAFLD by transient elastography in adult outpatients with type 1 diabetes. Patients were eligible if they did not have any known secondary cause of liver disease. NAFLD was defined as HS with or without fibrosis/cirrhosis. Associations between estimated glucose disposal rate (eGDR) and metabolic syndrome, as surrogate markers of insulin resistance, and NAFLD were explored using multivariate logistic regression models, adjusting for age, sex and diabetes duration.
RESULTS
We enrolled 150 consecutive subjects (age 47 ± 14 years, male 55%, diabetes duration 25 ± 14 years, median BMI 25 kg/m). NAFLD prevalence was 20% (n = 30). Thirty patients (20%) had HS. Five patients (3.3%) had HS with fibrosis. eGDR and metabolic syndrome were statistically significantly associated with the presence of NAFLD (OR 0.62, 95% CI 0.49-0.77, OR 7.62, 95% CI 2.95-19.77).
CONCLUSIONS
NAFLD prevalence in patients with type 1 diabetes is considerable, mainly restricted to isolated HS, while fibrosis is rare. Insulin resistance is associated with NAFLD in patients with type 1 diabetes.
目的
评估1型糖尿病患者未经过挑选的人群中肝脂肪变性（HS）和纤维化的患病率。描述其临床特征，并将胰岛素抵抗与非酒精性脂肪性肝病（NAFLD）之间的关联作为次要目标进行探究。
方法
我们采用瞬时弹性成像技术对成年1型糖尿病门诊患者的NAFLD进行前瞻性评估。如果患者没有任何已知的继发性肝病病因，则符合入选标准。NAFLD定义为伴有或不伴有纤维化/肝硬化的HS。使用多因素逻辑回归模型，在调整年龄、性别和糖尿病病程后，探究估计葡萄糖处置率（eGDR）和代谢综合征（作为胰岛素抵抗的替代指标）与NAFLD之间的关联。
结果
我们连续纳入了150名受试者（年龄47±14岁，男性占55%，糖尿病病程25±14年，BMI中位数为25kg/m²）。NAFLD患病率为20%（n = 30）。30名患者（20%）有HS。5名患者（3.3%）有伴有纤维化的HS。eGDR和代谢综合征与NAFLD的存在在统计学上显著相关（OR 0.62，95%CI 0.49 - 0.77，OR 7.62，95%CI 2.95 - 19.77）。
结论
1型糖尿病患者中NAFLD的患病率相当可观，主要局限于单纯性HS，而纤维化很少见。胰岛素抵抗与1型糖尿病患者的NAFLD相关。
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