Queensland Diabetes and Endocrine Centre, Mater Hospital Brisbane, Queensland, Australia.
Translational Research Institute, Australia.
J Diabetes Complications. 2024 Nov;38(11):108870. doi: 10.1016/j.jdiacomp.2024.108870. Epub 2024 Sep 17.
Glycogenic hepatopathy is associated with significant psychosocial consequences and health costs. Metabolic Dysfunction-Associated Steatotic Liver Disease and glycogenic hepatopathy are frequently confused as "fatty liver" when seen on ultrasonography. We wished to examine liver fat and glycogen content in groups defined based on metabolic and liver disease phenotypes.
This case-control study undertaken in a tertiary hospital used nuclear proton magnetic resonance spectroscopy (H-MRS) to examine liver fat and glycogen content in five clinical groups, each containing five participants: 1. type 1 diabetes with glycogenic hepatopathy, 2. satisfactorily controlled type 1 diabetes with no liver disease, 3. poorly controlled type 1 diabetes without liver disease, 4. a control group of body mass index- and age-matched individuals without diabetes or liver disease, and 5. hepatic steatosis.
Fat content was highest in the hepatic steatosis (median 15.4 %, IQR 10.0-19.3) and glycogenic hepatopathy (median 6.5 %, IQR 4.5-9.1) groups and compared to both of these groups was lower in the control group (median 1.0 %, IQR 0.7-1.1, p 0.002 and 0.022), the T1DM group with satisfactory control (median 0.3 %, IQR 0.2-0.6, p < 0.001 and <0.001), and the T1DM group with poor control without liver disease (median 1.1 %, IQR 0.9-1.1, p 0.001 and 0.012). No participants from the type 1 diabetes poor control, type 1 diabetes satisfactory control or the no diabetes groups had H-MRS-diagnosed hepatic steatosis. H-MRS glycogen content could not be interpreted in the majority of those with glycogenic hepatopathy because of interference from the fat signal.
In cases diagnosed with glycogenic hepatopathy there may be significant concomitant fat accumulation, compounding the already elevated cardiovascular risk in this cohort. The technique of H-MRS has not been demonstrated to be useful for diagnosing glycogenic hepatopathy.
糖原贮积性肝病与显著的社会心理后果和健康成本相关。代谢功能障碍相关的脂肪性肝病和糖原贮积性肝病在超声检查时经常被误诊为“脂肪肝”。我们希望在基于代谢和肝病表型定义的组中检查肝脂肪和糖原含量。
这项在一家三级医院进行的病例对照研究使用核质子磁共振波谱（H-MRS）检查了五个临床组中肝脂肪和糖原含量，每个组包含五名参与者：1. 伴糖原贮积性肝病的 1 型糖尿病，2. 控制良好的无肝病的 1 型糖尿病，3. 控制不佳的无肝病的 1 型糖尿病，4. 匹配年龄和体重指数的无糖尿病或肝病的对照组，5. 肝脂肪变性。
肝脂肪变性（中位数 15.4%，IQR 10.0-19.3）和糖原贮积性肝病（中位数 6.5%，IQR 4.5-9.1）组的脂肪含量最高，与这两组相比，对照组（中位数 1.0%，IQR 0.7-1.1，p 0.002 和 0.022）、控制良好的 1 型糖尿病组（中位数 0.3%，IQR 0.2-0.6，p < 0.001 和 <0.001）和无肝病的控制不佳的 1 型糖尿病组（中位数 1.1%，IQR 0.9-1.1，p 0.001 和 0.012）的脂肪含量较低。没有 1 型糖尿病控制不佳、1 型糖尿病控制良好或无糖尿病组的参与者通过 H-MRS 诊断为肝脂肪变性。由于脂肪信号的干扰，糖原贮积性肝病的大多数患者的 H-MRS 糖原含量无法解释。
在诊断为糖原贮积性肝病的病例中，可能存在明显的脂肪堆积，使该队列的心血管风险已经升高。H-MRS 技术尚未被证明可用于诊断糖原贮积性肝病。
