Chhabra Sandeep, Singh Sukhraj P, Singh Arshdeep, Mehta Varun, Kaur Amninder, Bansal Namita, Sood Ajit
Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, India.
Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, India.
J Clin Exp Hepatol. 2022 Mar-Apr;12(2):409-416. doi: 10.1016/j.jceh.2021.07.001. Epub 2021 Jul 9.
Diabetes mellitus is associated with an increased risk of development of non-alcoholic fatty liver disease (NAFLD). However, the risk posed by diabetes mellitus in progression of liver disease is uncertain. This study compared the severity of hepatic fibrosis in patients with NAFLD with and without diabetes mellitus.
Consecutive adult patients with NAFLD undergoing transient elastography [FibroScan Touch 502 (Echosens, Paris, France)] at a tertiary care center in north India were analyzed for severity of hepatic fibrosis. The aspartate aminotransferase (AST) to platelet ratio index (APRI), fibrosis index based on 4 factors (FIB-4), and NAFLD Fibrosis Score (NFS) were calculated. The degree of hepatic fibrosis as determined by FibroScan and non-invasive serum fibrosis models in patients with and without diabetes mellitus were compared.
A total of two hundred patients [118 (59%) males, mean age 50.30 ± 11.13 years] were enrolled. Significant hepatic fibrosis was present in 86 (43%) patients [mean age 50.66 ± 10.96 years, 56 (65.11%) males]. The mean FibroScan, APRI, FIB-4, and NFS scores were 9.86 ± 2.97, 0.75 ± 0.47, 2.41 ± 1.41 and -0.24 ± 1.43 in patients with diabetes compared to 5.31 ± 1.09, 0.49 ± 0.27, 1.55 ± 0.85, and -2.12 ± 1.88 in patients without diabetes, respectively (=<0.0001). There was a fair correlation between FibroScan and non-invasive serum fibrosis models (=<0.0001).
Presence of diabetes increases the risk of significant hepatic fibrosis in patients with NAFLD. FIB-4 correlates fairly with FibroScan in patients with diabetes and can be used as a screening tool to detect significant hepatic fibrosis.
糖尿病与非酒精性脂肪性肝病（NAFLD）的发病风险增加相关。然而，糖尿病在肝病进展中所带来的风险尚不确定。本研究比较了合并和未合并糖尿病的NAFLD患者肝纤维化的严重程度。
在印度北部一家三级医疗中心，对连续接受瞬时弹性成像[FibroScan Touch 502（法国巴黎Echosens公司）]检查的成年NAFLD患者的肝纤维化严重程度进行分析。计算天冬氨酸氨基转移酶（AST）与血小板比值指数（APRI）、基于4项因子的纤维化指数（FIB-4）以及NAFLD纤维化评分（NFS）。比较了通过FibroScan测定的肝纤维化程度以及合并和未合并糖尿病患者的非侵入性血清纤维化模型。
共纳入200例患者[118例（59%）为男性，平均年龄50.30±11.13岁]。86例（43%）患者存在显著肝纤维化[平均年龄50.66±10.96岁，56例（65.11%）为男性]。糖尿病患者的平均FibroScan、APRI、FIB-4和NFS评分分别为9.86±2.97、0.75±0.47、2.41±1.41和-0.24±1.43，而未患糖尿病患者分别为5.31±1.09、0.49±0.27、1.55±0.85和-2.12±1.88（P<0.0001）。FibroScan与非侵入性血清纤维化模型之间存在良好相关性（P<0.0001）。
糖尿病的存在增加了NAFLD患者发生显著肝纤维化的风险。在糖尿病患者中，FIB-4与FibroScan有较好的相关性，可作为检测显著肝纤维化的筛查工具。
