Binet Quentin, Loumaye Audrey, Hermans Michel P, Lanthier Nicolas
Service d'Hépato-Gastroentérologie, Cliniques universitaires Saint-Luc, UCLouvain, Brussels, Belgium.
Service d'Endocrinologie et Nutrition, Cliniques universitaires Saint-Luc, UCLouvain, Brussels, Belgium.
J Clin Transl Hepatol. 2023 Nov 28;11(6):1377-1386. doi: 10.14218/JCTH.2023.00117. Epub 2023 Jun 30.
Most data on liver assessment in type 2 diabetes mellitus (T2DM) patients are from retrospective cohorts with selection bias. We aimed at appraising the feasibility, results, and benefits of an outpatient systematic noninvasive screening for metabolic dysfunction-associated fatty liver disease (MAFLD) severity and determinants in T2DM patients.
We conducted a 50-week cross-sectional study enrolling adult T2DM outpatients from a diabetes clinic. An algorithm based on guidelines was applied using simple bioclinical scores and, if applicable, ultrasound and/or elastometry.
Two hundred and thirteen patients were included. Mean age and body mass index were 62 years and 31 kg/m and 29% of patients had abnormal transaminase levels. The acceptance rate of additional liver examinations was 92%. The prevalence of MAFLD, advanced fibrosis and cirrhosis was 87%, 11%, and 4%, respectively. More than half of the cases of advanced fibrosis had not been suspected and were detected by this screening. MAFLD was associated with poor glycemic control, elevated transaminases, low HDL-C and the absence of peripheral arterial disease. Advanced fibrosis was linked to high waist circumference and excessive alcohol consumption, which should be interpreted with caution owing to the small number of patients reporting excessive consumption.
Simple bioclinical tools allowed routine triage of T2DM patients for MAFLD severity, with high adherence of high-risk patients to subsequent noninvasive exams.
大多数关于2型糖尿病（T2DM）患者肝脏评估的数据来自存在选择偏倚的回顾性队列研究。我们旨在评估对T2DM患者进行门诊系统性非侵入性筛查代谢功能障碍相关脂肪性肝病（MAFLD）严重程度及其决定因素的可行性、结果和益处。
我们进行了一项为期50周的横断面研究，纳入了一家糖尿病诊所的成年T2DM门诊患者。应用基于指南的算法，使用简单的生物临床评分，并在适用时结合超声和/或弹性成像检查。
共纳入213例患者。平均年龄和体重指数分别为62岁和31kg/m²，29%的患者转氨酶水平异常。额外肝脏检查的接受率为92%。MAFLD、晚期纤维化和肝硬化的患病率分别为87%、11%和4%。超过一半的晚期纤维化病例此前未被怀疑，而是通过此次筛查发现的。MAFLD与血糖控制不佳、转氨酶升高、高密度脂蛋白胆固醇（HDL-C）降低以及外周动脉疾病的缺失有关。晚期纤维化与高腰围和过量饮酒有关，但由于报告过量饮酒的患者数量较少，对此应谨慎解读。
简单的生物临床工具可对T2DM患者的MAFLD严重程度进行常规分类，高危患者对后续非侵入性检查的依从性较高。
