He Yifei, Xiao Feng, Yi Bin, Lu Jin
Department of Endocrinology, Changhai Hospital, Naval Medical University, Shanghai, People's Republic of China.
Department of Liver Transplantation, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, People's Republic of China.
PLOS Glob Public Health. 2024 Dec 30;4(12):e0003572. doi: 10.1371/journal.pgph.0003572. eCollection 2024.
To estimate the prevalence and associated factors of hepatic steatosis and fibrosis in adults with type 2 diabetes (T2DM) in the United States.Data were retrieved from the 2017‒March 2020 prepandemic cycle of the National Health and Nutritional Examination and Survey (NHANES). The study population included patients with T2DM. The controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) were used to assess hepatic steatosis and fibrosis, respectively. A total of 1,290 T2DM patients were included, 85.2% (1044 patients) of whom presented with hepatic steatosis (CAP>248 dB/m). Among the 1044 T2DM patients with metabolically associated fatty liver disease (MAFLD), 29.5% developed hepatic fibrosis (LSM>8 kPa). Non-Hispanic black individuals (adjusted OR = 0.4008), BMI (adjusted OR = 1.1627), HbA1c (adjusted OR = 1.1450), TG (adjusted OR = 1.2347), HDL (adjusted OR = 0.4981), ALT (adjusted OR = 1.0227), AST (adjusted OR = 0.9396), and albumin (adjusted OR = 1.7030) were independently associated with steatosis. Age (adjusted OR = 1.0300), female sex (adjusted OR = 0.6655), BMI (adjusted OR = 1.1324), AST (adjusted OR = 1.0483), and GGT (adjusted OR = 1.0101) were independently associated with fibrosis. Heart failure was an independent factor associated with advanced fibrosis (adjusted OR = 1.9129) and cirrhosis (adjusted OR = 2.228). In the United States, hepatic steatosis is highly prevalent among T2DM patients, with 29.5% of these patients developing hepatic fibrosis. Some components of metabolic syndrome are related to hepatic steatosis and fibrosis. Moreover, heart failure is an independent factor associated with advanced fibrosis and cirrhosis.
评估美国2型糖尿病（T2DM）成人患者肝脂肪变性和肝纤维化的患病率及相关因素。数据来自2017年至2020年3月大流行前周期的美国国家健康与营养检查调查（NHANES）。研究人群包括T2DM患者。分别使用受控衰减参数（CAP）和肝脏硬度测量（LSM）来评估肝脂肪变性和肝纤维化。共纳入1290例T2DM患者，其中85.2%（1044例患者）存在肝脂肪变性（CAP>248 dB/m）。在1044例患有代谢相关脂肪性肝病（MAFLD）的T2DM患者中，29.5%发生了肝纤维化（LSM>8 kPa）。非西班牙裔黑人个体（校正OR = 0.4008）、体重指数（BMI）（校正OR = 1.1627）、糖化血红蛋白（HbA1c）（校正OR = 1.1450）､甘油三酯（TG）（校正OR = 1.2347）、高密度脂蛋白（HDL）（校正OR = 0.4981）、谷丙转氨酶（ALT）（校正OR = 1.0227）、谷草转氨酶（AST）（校正OR = 0.9396）和白蛋白（校正OR = 1.7030）与脂肪变性独立相关。年龄（校正OR = 1.0300）、女性（校正OR = 0.6655）、BMI（校正OR = 1.132 4）、AST（校正OR = 1.0483）和γ-谷氨酰转移酶（GGT）（校正OR = 1.0101）与纤维化独立相关。心力衰竭是与晚期纤维化（校正OR = 1.9129）和肝硬化（校正OR = 2.228）相关的独立因素。在美国，肝脂肪变性在T2DM患者中非常普遍，其中29.5%的患者发生了肝纤维化。代谢综合征的一些组分与肝脂肪变性和肝纤维化有关。此外，心力衰竭是与晚期纤维化和肝硬化相关的独立因素。
