de Vries Marieke, El-Morabit Fatima, van Erpecum Karel J, Westerink Jan, Bac Simon T, Kaasjager H A H Karin, de Valk Harold W
Department of Internal Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Gastroenterology, University Medical Center Utrecht, Utrecht, the Netherlands.
Eur J Intern Med. 2022 Jun;100:77-82. doi: 10.1016/j.ejim.2022.03.025. Epub 2022 Apr 3.
To compare NAFLD prevalence, distribution and its etiologic determinants in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D).
In this cross-sectional study, NAFLD was evaluated by transient elastography in adult outpatients with T1D and T2D. NAFLD was defined as hepatic steatosis with or without fibrosis. Associations between insulin resistance related factors and NAFLD and advanced fibrosis (≥ F3) were explored in T1D and T2D separately, using multivariate logistic regression models. Interaction analysis was performed to compare the associations in patients with T1D and T2D.
One hundred and fifty patients with T1D (mean age 47 years, male 55%, mean diabetes duration 25 years, median BMI 25 kg/m) and 100 patients with T2D (median age 67 years, male 56%, median diabetes duration 17 years, mean BMI 30 kg/m) were included. NAFLD prevalence was 20% in patients with T1D and 76% in patients with T2D. Advanced fibrosis prevalence was 2.0% in patients with T1D and 22% in patients with T2D. In both patients with T1D and T2D, waist circumference, BMI and metabolic syndrome were positively associated, and estimated insulin sensitivity was negatively associated with the presence of NAFLD, adjusted for age, sex and diabetes duration. There was no effect modification by diabetes type for any of these associations.
Despite differences in population characteristics and pathophysiology between T1D and T2D, insulin resistance related factors are similarly associated with NAFLD in both groups.
比较1型糖尿病（T1D）和2型糖尿病（T2D）患者的非酒精性脂肪性肝病（NAFLD）患病率、分布情况及其病因决定因素。
在这项横断面研究中，通过瞬时弹性成像技术对成年T1D和T2D门诊患者进行NAFLD评估。NAFLD定义为伴有或不伴有纤维化的肝脂肪变性。分别在T1D和T2D患者中，使用多因素逻辑回归模型探讨胰岛素抵抗相关因素与NAFLD及进展性纤维化（≥F3）之间的关联。进行交互分析以比较T1D和T2D患者中的关联。
纳入了150例T1D患者（平均年龄47岁，男性占55%，平均糖尿病病程25年，BMI中位数25kg/m）和100例T2D患者（年龄中位数67岁，男性占56%，糖尿病病程中位数17年，平均BMI 30kg/m）。T1D患者的NAFLD患病率为20%，T2D患者为76%。T1D患者的进展性纤维化患病率为2.0%，T2D患者为22%。在T1D和T2D患者中，调整年龄、性别和糖尿病病程后，腰围、BMI和代谢综合征与NAFLD呈正相关，估计的胰岛素敏感性与NAFLD的存在呈负相关。这些关联中没有任何一种受糖尿病类型的影响修饰作用。
尽管T1D和T2D在人群特征和病理生理学方面存在差异，但两组中胰岛素抵抗相关因素与NAFLD的关联相似。
