Diabetology and Endocrinology, Nuovo Ospdale degli Infermi di Biella, Ponderano, Biella, 13875, Italy.
Section of Endocrinology and Metabolism, Department of Medicine, University of Perugia, Piazzale Gambuli 1, Perugia, 06129, Italy.
Endocrine. 2024 May;84(2):412-419. doi: 10.1007/s12020-024-03715-5. Epub 2024 Feb 12.
Non-Alcoholic-Fatty-Liver-Disease (NAFLD) is the most common cause of chronic liver disease in Western countries; closely linked to obesity and type 2 diabetes (T2DM), it is an additional cardiovascular risk factor. The aim of this study is to investigate the prevalence of NAFLD at T2DM onset.
122 newly diagnosed T2DM patients were enroled; NAFLD was diagnosed using ultrasound and fibrosis risk calculated with an FIB4-score. Intermediate and high-risk patients were referred to a hepatologist and underwent transient elastography (TE).
At T2DM diagnosis, 25% of patients were overweight, 47% were obese; ultrasound steatosis was present in 79% of patients; the average FIB-4 score was 1.4 (0.7). The NAFLD population was characterised by higher presence of obesity (60%, p 0.06); hypertension (56%, p 0.00); AST (26.3 (23.6) UI/L; p 0.00); ALT (49.3(41.0) UI/L p 0.00); FIB-4 score (1.6 (0.8); p 0.00). Among patients referred to a hepatologist, at TE, 65% had severe steatosis, 22% significant fibrosis and 25% advanced fibrosis.
This is the first proposal of a NAFLD screening model at T2DM diagnosis. The high prevalence of fibrosis found at the early stage T2DM confirms the compelling need for early management of NAFLD through cost-effective screening and long-term monitoring algorithms.
非酒精性脂肪性肝病（NAFLD）是西方国家最常见的慢性肝病病因；与肥胖和 2 型糖尿病（T2DM）密切相关，它是心血管疾病的另一个危险因素。本研究旨在探讨 T2DM 发病时 NAFLD 的患病率。
纳入 122 例新诊断的 T2DM 患者；使用超声诊断 NAFLD，用 FIB4 评分计算纤维化风险。中高危患者转介至肝病科，行瞬时弹性成像（TE）检查。
在 T2DM 诊断时，25%的患者超重，47%的患者肥胖；79%的患者存在超声脂肪变性；平均 FIB-4 评分为 1.4（0.7）。NAFLD 人群的肥胖（60%，p=0.06）、高血压（56%，p=0.00）、AST（26.3（23.6）UI/L；p=0.00）、ALT（49.3（41.0）UI/L；p=0.00）、FIB-4 评分（1.6（0.8）；p=0.00）更高。在转介至肝病科的患者中，TE 检查发现 65%有严重脂肪变性，22%有显著纤维化，25%有进展性纤维化。
这是 T2DM 诊断时首次提出的 NAFLD 筛查模型。在 T2DM 早期就发现了高比例的纤维化，这证实了迫切需要通过具有成本效益的筛查和长期监测算法来早期管理 NAFLD。
