Lyu C, Fu W L, Gu Y, Wang L S, Wang X M, Liu X, Qian J M, Tao Z, Chen Y, Liu C, He R L, Guan X, Wang Y, Wang Y, Qi X L
Co-Management of Diabetes-Liver Disease Center of Shengyang, Shenyang 110006, China.
Department of Internal Medicine, Heping District Central Hospital, Shenyang 110001, China.
Zhonghua Gan Zang Bing Za Zhi. 2022 Nov 20;30(11):1194-1200. doi: 10.3760/cma.j.cn501113-20210810-00390.
To investigate the prevalence and independent risk factors of non-alcoholic fatty liver disease (NAFLD) and advanced chronic liver disease among the type 2 diabetes mellitus (T2DM) population in the Shenyang community, so as to provide evidence for the prevention and control of T2DM combined with NAFLD. This cross-sectional study was conducted in July 2021. 644 T2DM cases from 13 communities in Heping District, Shenyang City were selected. All the surveyed subjects underwent physical examination (measurements of height, body mass index, neck circumference, waist circumference, abdominal circumference, hip circumference, and blood pressure), infection screening (excluding hepatitis B and C, AIDS, and syphilis), random fingertip blood glucose, controlled attenuation parameter (CAP), and liver stiffness measurement (LSM). The study subjects were divided into the non-advanced chronic liver disease group and the advanced chronic liver disease group according to whether the LSM value was greater than 10 kPa. Cirrhotic portal hypertension development was indicated in patients with LSM ≥ 15 kPa. The comparison of multiple mean values among the sample groups was performed by analysis of variance when the normal distribution was met. In the T2DM community population, there were 401 cases (62.27%) combined with NAFLD, 63 cases (9.78%) combined with advanced chronic liver disease, and 14 cases (2.17%) combined with portal hypertension. There were 581 cases in the non-advanced chronic liver disease group and 63 cases (9.78%) in the advanced chronic liver disease group (LSM ≥10 kPa), including 49 cases (7.61%) with 10 kPa≤LSM<15 kPa, 11 cases (1.71%) with 15 kPa ≤LSM<25 kPa, and 3 cases (0.47%) with LSM ≥ 25 kPa. Age, body mass, body mass index, neck circumference, waist circumference, hip circumference, waist-to-height ratio, systolic blood pressure, and CAP were all statistically different between the non-advanced chronic liver disease group and the advanced chronic liver disease group (=-1.983,-2.598,-4.091,-2.062,-3.909, -4.581,-4.295,-2.474, and -5.191, respectively; <0.05). There was a statistically significant difference in terms of whether or not there was combined cerebrovascular disease (2=4.632, =0.031); however, there were no statistically significant differences in terms of lifestyle, diabetes complications, and other complications (>0.05). Patients with T2DM have a higher prevalence of NAFLD (62.27%) than those with advanced chronic liver disease (9.78%). 2.17% of T2DM cases in the community may not have had early diagnosis and early intervention, and they might have been combined with cirrhotic portal hypertension. So, the management of these patients should be strengthened.
为调查沈阳市社区2型糖尿病(T2DM)人群中非酒精性脂肪性肝病(NAFLD)及晚期慢性肝病的患病率和独立危险因素,为T2DM合并NAFLD的防治提供依据。本横断面研究于2021年7月开展。选取沈阳市和平区13个社区的644例T2DM患者。所有被调查对象均接受体格检查(测量身高、体重指数、颈围、腰围、腹围、臀围及血压)、感染筛查(排除乙肝、丙肝、艾滋病及梅毒)、随机指尖血糖、受控衰减参数(CAP)及肝脏硬度值测定(LSM)。根据LSM值是否大于10 kPa将研究对象分为非晚期慢性肝病组和晚期慢性肝病组。LSM≥15 kPa提示存在肝硬化门静脉高压进展。当满足正态分布时,采用方差分析对样本组间多个均值进行比较。在T2DM社区人群中,合并NAFLD者401例(62.27%),合并晚期慢性肝病者63例(9.78%),合并门静脉高压者14例(2.17%)。非晚期慢性肝病组581例,晚期慢性肝病组63例(9.78%,LSM≥10 kPa),其中10 kPa≤LSM<15 kPa者49例(7.61%),15 kPa≤LSM<25 kPa者11例(1.71%),LSM≥25 kPa者3例(0.47%)。非晚期慢性肝病组与晚期慢性肝病组在年龄、体重、体重指数、颈围、腰围、臀围、腰高比、收缩压及CAP方面均存在统计学差异(分别为=-1.983、-2.598、-4.091、-2.062、-3.909、-4.581、-4.295、-2.474及-5.191;<0.05)。在是否合并脑血管病方面存在统计学差异(2=4.632,=0.031);然而,在生活方式、糖尿病并发症及其他并发症方面无统计学差异(>0.05)。T2DM患者中NAFLD的患病率(62.27%)高于晚期慢性肝病(9.78%)。社区中2.17%的T2DM患者可能未得到早期诊断和早期干预,且可能合并肝硬化门静脉高压。因此,应加强对这些患者的管理。