Department of Internal Medicine, Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga 849-8501, Japan.
Internal Medicine, Heiwadai Hospital, Miyazaki 880-0034, Japan.
Nutrients. 2023 Jul 22;15(14):3248. doi: 10.3390/nu15143248.
Diabetic nephropathy (DN) is a major complication of diabetes. Nonalcoholic fatty liver disease (NAFLD) is common in diabetes, and liver fibrosis is a prognostic risk factor for NAFLD. The interaction between DN and liver fibrosis in NAFLD remains unclear. In 189 patients with DN and NAFLD who received an education course about diabetic nephropathy, liver fibrosis was evaluated using the fibrosis-4 (FIB-4) index. The association between the outcome of DN and changes in liver fibrosis was examined. The FIB-4 index was maintained at the baseline level in patients with improved DN, while it was increased in other patients. The ΔFIB-4 index was positively correlated with changes in albuminuria and proteinuria (ρ = 0.22, = 0.004). In a multivariate analysis, changes in albuminuria and proteinuria were associated with the ΔFIB-4 index ( = 0.002). Patients with a progressive FIB-4 index category from baseline to 5 years showed a lower event-free survival rate after 5 years than patients with an improved FIB-4 index category ( = 0.037). The outcome of DN is associated with changes in liver fibrosis in patients with diabetes, NAFLD and DN. Developing a preventive and therapeutic approach for these conditions is required.
糖尿病肾病（DN）是糖尿病的主要并发症。非酒精性脂肪性肝病（NAFLD）在糖尿病中很常见，肝纤维化是 NAFLD 的预后危险因素。DN 和 NAFLD 中的肝纤维化之间的相互作用尚不清楚。在接受糖尿病肾病教育课程的 189 名患有 DN 和 NAFLD 的患者中，使用纤维化-4（FIB-4）指数评估了肝纤维化。检查了 DN 结局与肝纤维化变化之间的关联。在 DN 改善的患者中，FIB-4 指数保持在基线水平，而在其他患者中则增加。ΔFIB-4 指数与白蛋白尿和蛋白尿的变化呈正相关（ρ=0.22， = 0.004）。在多变量分析中，白蛋白尿和蛋白尿的变化与ΔFIB-4 指数相关（ = 0.002）。从基线到 5 年期间 FIB-4 指数类别进展的患者在 5 年后的无事件生存率低于 FIB-4 指数类别改善的患者（ = 0.037）。糖尿病、NAFLD 和 DN 患者的 DN 结局与肝纤维化的变化相关。需要开发针对这些疾病的预防和治疗方法。
