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2型糖尿病(T2DM)患者肝脂肪变性和肝纤维化的患病率及特征:中国东部人群的横断面研究

Prevalence and characteristics of liver steatosis and fibrosis in type 2 diabetes mellitus (T2DM) patients: a cross-sectional study in populations of eastern China.

作者信息

Yu Hekai, Su Xianghui, Tao Wenxuan, Sun Weixia, Zhang Xiaoyan, Han Qing, Zhao Zhuoxiao, Zhang Yan, Chen Xiaoqian, Liu Xinliang, Jia Dianrong, Fang Li, Li Ling

机构信息

Department of Endocrinology, Southeast University, Nanjing, Jiangsu, China.

Southeast University, Nanjing, Jiangsu, China.

出版信息

BMJ Open. 2024 Dec 12;14(12):e087550. doi: 10.1136/bmjopen-2024-087550.

Abstract

OBJECTIVES

To describe the prevalence, clinical characteristics and risk factors of liver steatosis and fibrosis in type 2 diabetes mellitus (T2DM) patients in eastern China.

DESIGN

A cross-sectional, multicentre study based on an ongoing cohort study.

SETTING

16 clinics in eastern China, including primary clinics to tertiary hospitals.

PARTICIPANTS

1816 patients with T2DM diagnosis who met the inclusion criteria were recruited into the study.

INTERVENTION

Participants underwent elastography examination.

MAIN OUTCOME MEASURES

Descriptive analysis was performed to calculate the prevalence and characteristics of liver steatosis and fibrosis. The correlated factors were analysed using single- and multivariate logistic regression analysis.

RESULTS

The prevalence of liver steatosis in T2DM patients is 69.7%, with 46% moderate to severe steatosis. 34.6% and 6.7% of the patients were detected with liver fibrosis and cirrhosis. Steatosis patients were younger, had higher body mass index (BMI), higher levels of insulin resistance and more severe lipid metabolism disorders. Similar trends of differences were observed in patients with fibrosis. Female gender (OR=0.574, 95% CI 0.381 to 0.865), BMI (OR=1.491, 95% CI 1.375 to 1.616), disease duration, inflammation and serum lipid profile markers were risk factors of steatosis, while BMI (OR=1.204, 95% CI 1.137 to 1.275) and female gender (OR=0.672, 95% CI 0.470 to 0.961) were still the most significant predictors of liver fibrosis.

CONCLUSIONS

The prevalence of liver steatosis and fibrosis were high in patients with T2DM. Liver steatosis and fibrosis in these patients appeared to be more associated with lipid metabolism disorders and insulin resistance rather than glucose levels.

TRIAL REGISTRATION NUMBER

Clinical trial: NCT05597709.

摘要

目的

描述中国东部2型糖尿病(T2DM)患者肝脂肪变性和肝纤维化的患病率、临床特征及危险因素。

设计

基于一项正在进行的队列研究的横断面多中心研究。

地点

中国东部的16家诊所,包括基层诊所和三级医院。

参与者

招募了1816例符合纳入标准的T2DM诊断患者进入本研究。

干预措施

参与者接受弹性成像检查。

主要观察指标

进行描述性分析以计算肝脂肪变性和肝纤维化的患病率及特征。采用单因素和多因素逻辑回归分析相关因素。

结果

T2DM患者肝脂肪变性的患病率为69.7%,其中46%为中重度脂肪变性。34.6%和6.7%的患者被检测出有肝纤维化和肝硬化。脂肪变性患者更年轻,体重指数(BMI)更高,胰岛素抵抗水平更高,脂质代谢紊乱更严重。纤维化患者也观察到类似的差异趋势。女性(比值比[OR]=0.574,95%置信区间[CI]0.381至0.865)、BMI(OR=1.491,95%CI1.375至1.616)、病程、炎症和血脂谱标志物是脂肪变性的危险因素,而BMI(OR=1.204,95%CI1.137至1.275)和女性(OR=0.672,95%CI0.470至0.961)仍是肝纤维化最显著的预测因素。

结论

T2DM患者肝脂肪变性和肝纤维化的患病率较高。这些患者的肝脂肪变性和肝纤维化似乎与脂质代谢紊乱和胰岛素抵抗的关系更大,而非血糖水平。

试验注册号

临床试验:NCT05597709。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9779/11647396/b289bf3b4fc4/bmjopen-14-12-g001.jpg

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