Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy; School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.
Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy; School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.
Diabetes Res Clin Pract. 2022 Aug;190:109981. doi: 10.1016/j.diabres.2022.109981. Epub 2022 Jul 5.
BACKGROUND & AIMS: Liver stiffness is an indirect marker of liver fibrosis, which predicts clinical outcomes in patients with nonalcoholic fatty liver disease (NAFLD). The aim of the present systematic review and meta-analysis is to summarize evidence on the prevalence of elevated liver stiffness in patients with diabetes.
We systematically searched PubMed-MEDLINE and Scopus from inception to May 2022 for observational studies reporting the prevalence of elevated liver stiffness diagnosed by vibration controlled transient elastography (VCTE) in adult patients with either type 1 (T1D) or type 2 diabetes (T2D). Prevalence values from individual studies were meta-analyzed using random effects models. Subgroup and sensitivity analyses were performed to identify potential sources of heterogeneity.
Of the 428 titles initially scrutinized, 29 studies fulfilled the criteria and were included, providing data on 390 patients with T1D and 10,487 patients with T2D. Prevalence rates of elevated liver stiffness were 5.2% (95% CI 1.1-9.2) in patients with T1D and 19.8% (95% CI 16.8-22.8) in patients with T2D. In studies performed in patients with T2D, multivariate meta-regression analysis showed that higher body mass index, higher age, a higher proportion of males, lower VCTE cut-off and Asian ethnicity were associated with increased prevalence rates. This model explained 32.7% of the observed heterogeneity. No signs of publication bias were identified by visual inspection of the funnel plot or by Egger's test.
This meta-analysis indicates that 1 in 20 patients with T1D and 1 in 5 patients with T2D has elevated liver stiffness, indicative of potential significant or advanced liver fibrosis.
肝脏硬度是肝纤维化的间接标志物，可预测非酒精性脂肪性肝病（NAFLD）患者的临床结局。本系统评价和荟萃分析的目的是总结关于糖尿病患者肝硬度升高患病率的证据。
我们系统地检索了 PubMed-MEDLINE 和 Scopus 从创建到 2022 年 5 月的观察性研究，报告了通过振动控制瞬时弹性成像（VCTE）诊断的成年 1 型糖尿病（T1D）或 2 型糖尿病（T2D）患者肝硬度升高的患病率。使用随机效应模型对来自个别研究的患病率值进行荟萃分析。进行了亚组和敏感性分析，以确定异质性的潜在来源。
在最初仔细审查的 428 个标题中，有 29 项研究符合标准并被纳入，提供了 390 例 T1D 患者和 10487 例 T2D 患者的数据。T1D 患者肝硬度升高的患病率为 5.2%（95%CI 1.1-9.2），T2D 患者为 19.8%（95%CI 16.8-22.8）。在 T2D 患者中进行的研究中，多元荟萃回归分析表明，较高的体重指数、较高的年龄、较高的男性比例、较低的 VCTE 截止值和亚洲种族与较高的患病率相关。该模型解释了 32.7%的观察到的异质性。通过视觉检查漏斗图或 Egger 检验未发现发表偏倚的迹象。
本荟萃分析表明，1/20 的 T1D 患者和 1/5 的 T2D 患者肝硬度升高，提示可能存在显著或进展性肝纤维化。
