High Prevalence of Advanced Liver Fibrosis Assessed by Transient Elastography Among US Adults With Type 2 Diabetes
High Prevalence of Advanced Liver Fibrosis Assessed by Transient Elastography Among US Adults With Type 2 Diabetes
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DOI：
10.2337/dc20-1778
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发表时间：
2021-02-01
期刊：
影响因子：
16.2
通讯作者：
Perseghin, Gianluca
中科院分区：
文献类型：
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作者：
Ciardullo, Stefano;Monti, Tommaso;Perseghin, Gianluca
目的2型糖尿病(T2 DM)是代谢性肝病进展为晚期纤维化的重要危险因素。在这里，我们提供了基于瞬时弹性成像(TE)的美国成年T2 DM患者中脂肪变性和纤维化患病率的估计，并确定了与这些情况相关的因素。研究设计和方法是一项横断面研究，研究对象是参加2017-2018年国家健康和营养检查调查周期的美国T2 DM成年人，他们由TE进行评估。结果在825例TE检查结果可靠的患者中，M探头检出484例(53.7%)，XL探头检出341例(46.3%)。73.8%(95%可信区间68.5%~78.5%)、15.4%(95%可信区间12.2%~19.0%)和7.7%(95%可信区间4.8%~11.9%)分别出现肝脂肪变性(CAP>；=274DB/m)、晚期纤维化(LSM>；=9.7kPA)和肝硬变(LSM>；=13.6kPA)。晚期纤维化组和肝硬化组的平均+/-SE年龄分别为63.7±2.2岁和57.8±1.6岁。在多变量Logistic回归模型中，BMI、非黑人种族和ALT水平是脂肪变性的独立预测因素；BMI、非黑人种族、AST和γ-谷氨酰转肽酶水平是晚期纤维化的独立预测因素。结论美国T2 DM患者肝脏脂肪变性和纤维化的患病率较高，肥胖是主要危险因素。我们的结果支持在糖尿病患者中筛查这些情况。
OBJECTIVEType 2 diabetes mellitus (T2DM) is an important risk factor for the progression of metabolic liver disease to advanced fibrosis. Here, we provide an estimate of the prevalence of steatosis and fibrosis in U.S. adults with T2DM on the basis of transient elastography (TE) and identify factors associated with these conditions.RESEARCH DESIGN AND METHODSThis is a cross-sectional study of U.S. adults with T2DM participating in the 2017-2018 cycle of the National Health and Nutrition Examination Survey who were evaluated by TE. Hepatic steatosis and fibrosis were diagnosed by the median value of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), respectively.RESULTSAmong the 825 patients with reliable TE examination results, 484 (53.7%) were assessed using the M probe and 341 (46.3%) using the XL probe. Liver steatosis (CAP >= 274 dB/m), advanced fibrosis (LSM >= 9.7 kPa), and cirrhosis (LSM >= 13.6 kPa) were present in 73.8% (95% CI 68.5%-78.5%), 15.4% (95% CI 12.2%-19.0%), and 7.7% (95% CI 4.8%-11.9%) of patients, respectively. The mean +/- SE age of patients with advanced fibrosis and cirrhosis was 63.7 +/- 2.2 years and 57.8 +/- 1.6 years, respectively. In the multivariable logistic regression model, BMI, non-Black race, and ALT levels were independent predictors of steatosis; and BMI, non-Black race, and AST and gamma-glutamyltranspeptidase levels were independent predictors of advanced fibrosis.CONCLUSIONSPrevalence of both liver steatosis and fibrosis is high in patients with T2DM from the United States and obesity is a major risk factor. Our results support the screening of these conditions among patients with diabetes.