Teng Long, Luo Ling, Sun Yanhong, Wang Wei, Dong Zhi, Cao Xiaopei, Ye Junzhao, Zhong Bihui
Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan II Road, Yuexiu District, Guangzhou 510080, China.
Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-sen University, No. 183 Huangpu East Road, Huangpu District, Guangzhou 510080, China.
Nutrients. 2024 Dec 31;17(1):152. doi: 10.3390/nu17010152.
: The 1-h post-load plasma glucose was proposed to replace the current OGTT criteria for diagnosing prediabetes/diabetes. However, it remains unclear whether it is superior in identifying progressive metabolic dysfunction-associated steatotic liver disease (MASLD), and thus we aimed to clarify this issue. : Consecutive Asian participants (non-MASLD, = 1049; MASLD, = 1165) were retrospectively enrolled between June 2012 and June 2024. CT was used to quantify liver steatosis, while the serum liver fibrotic marker was used to evaluate liver fibrosis. : Compared with those with normal levels of both 1-h post-glucose (1hPG) and 2-h post-glucose (2hPG), patients with MASLD showed a significant positive association between elevated 1hPG levels and moderate to severe liver steatosis (odds ratio [OR] = 2.19, 95% confidence interval [CI]: 1.13-4.25, = 0.02]. Elevated levels of both 1hPG and 2hPG were associated with an increased risk of liver injury (OR = 2.03, 95% CI: 1.44-2.86, < 0.001). Elevated 2hPG levels with or without elevated 1hPG levels were associated with liver fibrosis (OR = 1.99, 95% CI: 1.15-3.45, < 0.001; OR = 2.72, 95% CI: 1.79-4.11, < 0.001, respectively). Additionally, either 1hPG or 2hPG levels were associated with atherosclerosis, revealing significant dose-dependent associations between glucose status and atherosclerosis risk (OR = 2.77, 95% CI: 1.55-4.96, < 0.001 for elevated 1hPG; OR = 2.98, 95% CI = 1.54-5.78, = 0.001 for elevated 2hPG; OR = 2.41, 95% CI = 1.38-4.21, = 0.001 for elevated levels of both 1hPG and 2hPG). The areas under the ROC for predicting steatosis, liver injury, liver fibrosis, and atherosclerosis were 0.64, 0.58, 0.58, and 0.64 for elevated 1hPG (all < 0.05) and 0.50, 0.60, 0.56, and 0.62 for elevated 2hPG (all < 0.05), respectively. : These findings underscore the necessity for clinicians to acknowledge that the screening and management of MALSD requires the monitoring of 1hPG levels.
有人提议用负荷后1小时血浆葡萄糖来取代目前用于诊断糖尿病前期/糖尿病的口服葡萄糖耐量试验（OGTT）标准。然而，它在识别进展性代谢功能障碍相关脂肪性肝病（MASLD）方面是否更具优势仍不清楚，因此我们旨在阐明这一问题。连续纳入2012年6月至2024年6月期间的亚洲参与者（非MASLD患者1049例；MASLD患者1165例）进行回顾性研究。采用CT定量肝脏脂肪变性，同时使用血清肝纤维化标志物评估肝纤维化。与葡萄糖后1小时（1hPG）和葡萄糖后2小时（2hPG）水平均正常的患者相比，MASLD患者中1hPG水平升高与中度至重度肝脏脂肪变性之间存在显著正相关（优势比[OR]=2.19，95%置信区间[CI]：1.13 - 4.25，P = 0.02）。1hPG和2hPG水平升高均与肝损伤风险增加相关（OR = 2.03，95% CI：1.44 - 2.86，P < 0.001）。无论1hPG水平是否升高，2hPG水平升高均与肝纤维化相关（OR分别为1.99，95% CI：1.15 - 3.45，P < 0.001；OR = 2.72，95% CI：1.79 - 4.11，P < 0.001）。此外，1hPG或2hPG水平均与动脉粥样硬化相关，显示出葡萄糖状态与动脉粥样硬化风险之间存在显著的剂量依赖性关联（1hPG升高时OR = 2.77，95% CI：1.55 - 4.96，P < 0.001；2hPG升高时OR = 2.98，95% CI = 1.54 - 5.78，P = 0.001；1hPG和2hPG水平均升高时OR = 2.41，95% CI = 1.38 - 4.21，P = 0.001）。预测脂肪变性、肝损伤、肝纤维化和动脉粥样硬化的ROC曲线下面积，1hPG升高时分别为0.64、0.58、0.58和0.64（均P < 0.05），2hPG升高时分别为0.50、0.60、0.56和0.62（均P < 0.05）。这些发现强调了临床医生必须认识到，MASLD的筛查和管理需要监测1hPG水平。
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