非酒精性脂肪性肝病合并糖尿病患者肝纤维化的随访研究：钠-葡萄糖共转运蛋白-2 抑制剂的肝保护作用。
Evolution of liver fibrosis in diabetic patients with NAFLD in a follow-up study: Hepatoprotective effects of sodium-glucose co-transporter-2 inhibitors.
机构信息
SC- Medicina-Indirizzo Metabolico, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
出版信息
Dig Liver Dis. 2024 Apr;56(4):551-558. doi: 10.1016/j.dld.2023.09.023. Epub 2023 Oct 14.
BACKGROUND AND AIMS
Patients with non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) are at high risk of hepatic fibrosis. To prospectively evaluate changes in fibrosis in diabetic patients with NAFLD, predisposing factors and sodium glucose cotransporter 2 inhibitors (SGLT2i) influence.
METHODS
237 T2DM outpatients (mean age 67 ± 9 years, 54% male) were enrolled and re-evaluated after 52 ± 10 months. At baseline and follow-up NAFLD and liver fibrosis (LSM) were detected by ultrasonography and Fibroscan®.
RESULTS
During follow-up an increase in LSM (6.0 ± 2.8 vs 5.8 ± 2.7 kPa, p = 0.02) and in the prescription of SGLT2i (20% vs 6%, p<0.001) was registered, despite stability of diabetic control. LSM worsened in 133(56%) subjects, 92 (39%) with worsening >10% from baseline. Patients with worsening versus non worsening of LSM had higher prevalence of increase in BMI during follow-up (45% vs 32%, p = 0.06) and lower SGLT2i prescription (15% vs 27%, p = 0.034). In multivariate analysis use of SGLT2-inhibitors at follow-up reduced the risk of LSM worsening (HR 0.34, 95% CI 0.13-0.88), even when considered>10% from baseline.
CONCLUSIONS
A high prevalence of fibrosis progression was observed in diabetic subjects with NAFLD over a nearly 5-years follow up and SGLT2-inhibitors seem to reduce the risk of worsening of liver stiffness.
背景与目的
非酒精性脂肪性肝病 (NAFLD) 和 2 型糖尿病 (T2DM) 患者存在发生肝纤维化的高风险。本研究旨在前瞻性评估糖尿病合并 NAFLD 患者的纤维化变化、易患因素以及钠-葡萄糖共转运蛋白 2 抑制剂 (SGLT2i) 的影响。
方法
本研究纳入了 237 例 T2DM 门诊患者（平均年龄 67 ± 9 岁，54%为男性），并在 52 ± 10 个月后对其进行了重新评估。在基线和随访时，通过超声和 Fibroscan®检测 NAFLD 和肝脏纤维化（LSM）。
结果
在随访期间，尽管糖尿病控制稳定，但 LSM（6.0 ± 2.8 比 5.8 ± 2.7 kPa，p = 0.02）和 SGLT2i 的处方（20%比 6%，p<0.001）均有所增加。LSM 恶化的患者有 133 例（56%），其中 92 例（39%）的基线 LSM 恶化>10%。与 LSM 无恶化的患者相比，LSM 恶化的患者在随访期间 BMI 增加的发生率更高（45%比 32%，p = 0.06），且 SGLT2i 的处方更低（15%比 27%，p = 0.034）。多变量分析显示，随访时使用 SGLT2i 抑制剂降低了 LSM 恶化的风险（HR 0.34，95%CI 0.13-0.88），即使考虑到基线 LSM 恶化>10%。
结论
在近 5 年的随访中，观察到糖尿病合并 NAFLD 患者的纤维化进展发生率较高，而 SGLT2i 似乎可降低肝脏硬度恶化的风险。
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