Barisic-Jaman Mislav, Milosevic Marko, Skurla Viktoria, Dohoczky David, Stojic Josip, Dinjar Kujundzic Petra, Cigrovski Berkovic Maja, Majic-Tengg Ana, Matijaca Ana, Lucijanic Tomo, Kardum-Pejic Mirjana, Pandzic Jaksic Vlatka, Marusic Srecko, Grgurevic Ivica
Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, 10000 Zagreb, Croatia.
Department of Endocrinology, Diabetes, Diseases of Metabolism and Clinical Pharmacology, University Hospital Dubrava, 10000 Zagreb, Croatia.
Biomedicines. 2024 Jan 30;12(2):323. doi: 10.3390/biomedicines12020323.
Patients with type 2 diabetes (T2D) are at risk of developing metabolic dysfunction-associated steatotic liver disease (MASLD). We investigated the prevalence of compensated advanced chronic liver disease (cACLD) and steatosis in patients with T2D using the new non-invasive diagnostic methods of shear wave measurements (SWMs) and attenuation (ATT) measurements in comparison with those of vibration-controlled transient elastography (VCTE) and the controlled attenuation parameter (CAP), which served as the reference methods. Among 214 T2D patients, steatosis at any grade and cACLD were revealed in 134 (62.6%) and 19 (8.9%) patients, respectively. SWMs showed a high correlation with VCTE (Spearman's = 0.641), whereas SWMs produced lower (mean of -0.7 kPa) liver stiffness measurements (LSMs) overall. At a LSM of >11.0 kPa (Youden), SWMs had an AUROC of 0.951 that was used to diagnose cACLD (defined as a LSM of >15 kPa through VCTE) with 84.2% sensitivity and 96.4% specificity. The performance of ATT measurements in diagnosing liver steatosis at any grade (defined as the CAP of ≥274 dB/m) was suboptimal (AUROC of 0.744 at the ATT measurement cut-off of >0.63 dB/cm/MHz (Youden) with 59% sensitivity and 81.2% specificity). In conclusion, the prevalence of liver steatosis and previously unrecognized cACLD in patients with T2D is high and SWMs appear to be a reliable diagnostic method for this purpose, whereas further investigation is needed to optimize the diagnostic performance of ATT measurements.
2型糖尿病（T2D）患者有发生代谢功能障碍相关脂肪性肝病（MASLD）的风险。我们采用剪切波测量（SWMs）和衰减（ATT）测量这两种新的非侵入性诊断方法，与作为参考方法的振动控制瞬时弹性成像（VCTE）和受控衰减参数（CAP）相比较，调查了T2D患者中代偿期晚期慢性肝病（cACLD）和脂肪变性的患病率。在214例T2D患者中，分别有134例（62.6%）和19例（8.9%）患者出现任何等级的脂肪变性和cACLD。SWMs与VCTE显示出高度相关性（Spearman相关系数 = 0.641），而SWMs总体上产生的肝脏硬度测量值（LSMs）较低（平均为 -0.7 kPa）。在LSM > 11.0 kPa（约登指数）时，SWMs诊断cACLD（通过VCTE定义为LSM > 15 kPa）的曲线下面积（AUROC）为0.951，灵敏度为84.2%，特异度为96.4%。ATT测量在诊断任何等级的肝脏脂肪变性（定义为CAP≥274 dB/m）方面的表现欠佳（在ATT测量临界值>0.63 dB/cm/MHz（约登指数）时，AUROC为0.744，灵敏度为59%，特异度为81.2%）。总之，T2D患者中肝脏脂肪变性和先前未被认识的cACLD的患病率较高，SWMs似乎是用于此目的的可靠诊断方法，而需要进一步研究以优化ATT测量的诊断性能。
