Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, 37126 Verona, Italy.
Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK.
Int J Mol Sci. 2022 Oct 18;23(20):12481. doi: 10.3390/ijms232012481.
Currently, there are limited data regarding the long-term effect of liver stiffness on glycaemic control in patients with type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD). We prospectively followed an outpatient sample of 61 consecutive postmenopausal women with T2DM and NAFLD who had baseline data on liver ultrasonography and Fibroscan-assessed liver stiffness measurement (LSM) in 2017 and who underwent follow-up in 2022. Haemoglobin A1c (HbA1c) was measured both at baseline and follow-up. At baseline, 52 patients had NAFLD (hepatic steatosis) alone, and 9 had NAFLD with coexisting clinically significant fibrosis (defined as LSM ≥ 7 kPa on Fibroscan). At follow-up, 16 patients had a worsening of glycaemic control (arbitrarily defined as HbA1c increase ≥ 0.5% from baseline). The prevalence of NAFLD and coexisting clinically significant fibrosis at baseline was at least three times greater among patients who developed worse glycaemic control at follow-up, compared with those who did not (31.3% vs. 8.9%; = 0.030). In logistic regression analysis, the presence of NAFLD and clinically significant fibrosis was associated with an approximately 4.5-fold increased likelihood of developing worse glycaemic control at follow-up (odds ratio 4.66, 95% confidence interval 1.07-20.3; = 0.041), even after adjustment for baseline confounding factors, such as age, body mass index, haemoglobin A1c (or HOMA-estimated insulin resistance) and use of some glucose-lowering agents that may positively affect NAFLD and liver fibrosis. In conclusion, our results suggest that the presence of Fibroscan-assessed significant fibrosis was associated with a higher risk of developing worse glycaemic control in postmenopausal women with T2DM and NAFLD.
目前，关于 2 型糖尿病（T2DM）和非酒精性脂肪性肝病（NAFLD）患者肝硬度对血糖控制的长期影响的数据有限。我们前瞻性随访了 2017 年基线时接受过肝脏超声和 Fibroscan 评估肝硬度测量（LSM）的 61 例连续绝经后 T2DM 和 NAFLD 门诊患者，并于 2022 年进行了随访。在基线和随访时均测量了糖化血红蛋白（HbA1c）。基线时，52 例患者仅有 NAFLD（肝脂肪变性），9 例患者存在同时伴有临床显著纤维化的 NAFLD（定义为 Fibroscan 上的 LSM≥7kPa）。随访时，16 例患者血糖控制恶化（任意定义为 HbA1c 较基线增加≥0.5%）。与血糖控制未恶化的患者相比，随访时血糖控制恶化的患者基线时存在 NAFLD 和并存临床显著纤维化的比例至少高出三倍（31.3%比 8.9%；=0.030）。在逻辑回归分析中，NAFLD 和临床显著纤维化的存在与随访时血糖控制恶化的可能性增加约 4.5 倍相关（优势比 4.66，95%置信区间 1.07-20.3；=0.041），即使在调整了基线混杂因素后，如年龄、体重指数、HbA1c（或 HOMA 估计的胰岛素抵抗）和使用一些可能对 NAFLD 和肝纤维化产生积极影响的降糖药物。总之，我们的研究结果表明，Fibroscan 评估的显著纤维化的存在与绝经后 T2DM 和 NAFLD 患者血糖控制恶化的风险增加相关。
