全球 2 型糖尿病中非酒精性脂肪性肝病的患病率：一项更新的系统评价和荟萃分析。

Global prevalence of non-alcoholic fatty liver disease in type 2 diabetes mellitus: an updated systematic review and meta-analysis.

机构信息

Department of Medicine, National University Hospital, Singapore.

Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

出版信息

Gut. 2023 Nov;72(11):2138-2148. doi: 10.1136/gutjnl-2023-330110. Epub 2023 Jul 25.

DOI:10.1136/gutjnl-2023-330110

PMID:37491159

Abstract

INTRODUCTION

Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease, with type 2 diabetes mellitus (T2DM) as a major predictor. Insulin resistance and chronic inflammation are key pathways in the pathogenesis of T2DM leading to NAFLD and vice versa, with the synergistic effect of NAFLD and T2DM increasing morbidity and mortality risks. This meta-analysis aims to quantify the prevalence of NAFLD and the prevalence of clinically significant and advanced fibrosis in people with T2DM.

METHODS

MEDLINE and Embase databases were searched from inception until 13 February 2023. The primary outcomes were the prevalence of NAFLD, non-alcoholic steatohepatitis (NASH) and fibrosis in people with T2DM. A generalised linear mixed model with Clopper-Pearson intervals was used for the analysis of proportions with sensitivity analysis conducted to explore heterogeneity between studies.

RESULTS

156 studies met the inclusion criteria, and a pooled analysis of 1 832 125 patients determined that the prevalence rates of NAFLD and NASH in T2DM were 65.04% (95% CI 61.79% to 68.15%, I=99.90%) and 31.55% (95% CI 17.12% to 50.70%, I=97.70%), respectively. 35.54% (95% CI 19.56% to 55.56%, I=100.00%) of individuals with T2DM with NAFLD had clinically significant fibrosis (F2-F4), while 14.95% (95% CI 11.03% to 19.95%, I=99.00%) had advanced fibrosis (F3-F4).

CONCLUSION

This study determined a high prevalence of NAFLD, NASH and fibrosis in people with T2DM. Increased efforts are required to prevent T2DM to combat the rising burden of NAFLD.

PROSPERO REGISTRATION NUMBER

CRD42022360251.

摘要

简介

非酒精性脂肪性肝病（NAFLD）是慢性肝病的主要病因，2 型糖尿病（T2DM）是其主要预测因素。胰岛素抵抗和慢性炎症是非酒精性脂肪性肝病（NAFLD）发病机制中的关键途径，反之亦然，NAFLD 和 T2DM 的协同作用增加了发病率和死亡率的风险。本荟萃分析旨在量化 T2DM 患者中 NAFLD 的患病率和临床显著纤维化及晚期纤维化的患病率。

方法

从建库起至 2023 年 2 月 13 日，我们在 MEDLINE 和 Embase 数据库中进行了检索。主要结局是 T2DM 患者中 NAFLD、非酒精性脂肪性肝炎（NASH）和纤维化的患病率。我们采用 Clopper-Pearson 区间的广义线性混合模型对比例进行分析，并进行敏感性分析以探索研究间的异质性。

结果

156 项研究符合纳入标准，对 1832125 例患者进行的汇总分析表明，T2DM 中 NAFLD 和 NASH 的患病率分别为 65.04%（95%CI61.79%至 68.15%，I=99.90%）和 31.55%（95%CI17.12%至 50.70%，I=97.70%）。在患有 NAFLD 的 T2DM 患者中，有 35.54%（95%CI19.56%至 55.56%，I=100.00%）存在临床显著纤维化（F2-F4），而 14.95%（95%CI11.03%至 19.95%，I=99.00%）存在晚期纤维化（F3-F4）。