医学
脂肪肝
内科学
瞬态弹性成像
糖尿病
蛋白尿
肾脏疾病
心房颤动
2型糖尿病
胃肠病学
2型糖尿病
慢性肝病
混淆
脂肪变性
疾病
肝硬化
内分泌学
肝纤维化
作者
Alessandro Mantovani,Teresa Turino,Maria Giovanna Lando,K. Gjini,Christopher D. Byrne,Chiara Zusi,Federico Ravaioli,Antonio Colecchia,Claudio Maffeis,Gian Luca Salvagno,Giuseppe Lippi,Enzo Bonora,Giovanni Targher
标识
DOI:10.1016/j.diabet.2019.11.004
摘要
Despite the high prevalence and serious clinical implications of non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM), NAFLD is usually overlooked during routine diabetes care. This study explored the proportion of NAFLD cases and increased liver fibrosis (LF), and the association between LF and either chronic kidney disease (CKD) or cardiovascular complications in T2DM patients. The study included 137 patients with non-insulin-treated T2DM and no known liver disease consecutively attending our diabetes outpatients’ service who underwent liver ultrasonography and liver stiffness measurement (LSM) using vibration-controlled transient elastography (FibroScan®). The proportion of patients with hepatic steatosis on ultrasonography was 73.7%, and the proportion with significant LF was 17.5% with an LSM cut-off ≥ 7 kPa or 10.2% with an LSM cut-off ≥ 8.7 kPa. The presence of CKD (estimated GFR < 60 mL/min/1.73 m2 and/or abnormal albuminuria) increased significantly across LSM tertiles (from around 15% in tertile 1 to 45% in tertile 3). Cardiovascular complications (previous ischaemic heart disease, ischaemic stroke, permanent atrial fibrillation) also tended to increase across LSM tertiles (from around 15% to 30%). After adjusting for established risk factors and potential confounders, LSM tertile 3 remained significantly associated with an approximately threefold higher risk of prevalent CKD (adjusted OR: 3.28, 95% CI: 1.22–8.90; P = 0.019), but not for cardiovascular complications. These results suggest that NAFLD and significant LF (as assessed by FibroScan®) are very commonly seen in T2DM outpatients with no known liver disease attending a secondary-care diabetes service, and that increased LF is associated with a greater proportion of chronic vascular complications, especially CKD.
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