Non-invasive screening of diabetics in primary care for NAFLD and advanced fibrosis by MRI and MRE.
Non-invasive screening of diabetics in primary care for NAFLD and advanced fibrosis by MRI and MRE.
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DOI：
10.1111/apt.13405
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发表时间：
2016-01
影响因子：
7.6
通讯作者：
Loomba R
中科院分区：
文献类型：
--
作者：
Doycheva I;Cui J;Nguyen P;Costa EA;Hooker J;Hofflich H;Bettencourt R;Brouha S;Sirlin CB;Loomba R
目前的指南不建议筛查非酒精性脂肪性肝病(NAFLD)或晚期纤维化。众所周知，2型糖尿病(T2 DM)患者患NAFLD和晚期纤维化的风险增加。我们的目的是评估糖尿病患者在初级保健环境中筛查NAFLD和晚期纤维化的可行性，方法是使用无创性磁共振成像(MRI)估计肝脏质子密度脂肪分数(MRI-PDFF)和磁共振弹性成像(MRE)估计肝脏硬度。我们进行了一项前瞻性研究的横断面分析，其中包括100名(53%男性)连续入选的糖尿病患者，他们没有任何其他肝病病因。所有患者都接受了标准化的研究访问、实验室测试、MRI-PDFF和MRE。平均年龄(±SD)为59.7(±11.2)岁，BMI为30.8(±6.5)kg/m2。非酒精性脂肪肝(定义为≥-PDFF5%)和晚期纤维化(定义为≥3.6kPa)的患病率分别为65%和7.1%。1例晚期纤维化患者确诊为肝细胞癌。与非酒精性脂肪肝患者相比，非酒精性脂肪肝患者更年轻(p=0.028)，平均体重指数(p=0.0008)、腰围(p<；0.0001)和代谢综合征患病率(84.6%vs.40.0%，p<；0.0001)较高。NAFLD患者中只有26%的ALT升高。这项概念验证研究表明，T2 DM有显著的NAFLD和晚期纤维化发生率。在T2 DM患者中使用MRI-PDFF和MRE同时筛查NAFLD和晚期纤维化是可行的，可以在更大的队列中进行验证后考虑。
Current guidelines do not recommend screening for nonalcoholic fatty liver disease (NAFLD) or advanced fibrosis. Patients with type 2 diabetes mellitus (T2DM) are known to be at increased risk for NAFLD and advanced fibrosis. We aimed to assess the feasibility in diabetics in a primary care setting of screening for NAFLD and advanced fibrosis by using non-invasive magnetic resonance imaging (MRI) to estimate the hepatic proton density fat fraction (MRI-PDFF) and magnetic resonance elastography (MRE) to estimate hepatic stiffness. We performed a cross-sectional analysis of a prospective study that included 100 (53% men) consecutively enrolled diabetics who did not have any other etiology of liver disease. All patients underwent a standardized research visit, laboratory tests, MRI-PDFF, and MRE. Mean (± SD) age and BMI was 59.7 (±11.2) years and 30.8 (±6.5) kg/m2, respectively. The prevalence of NAFLD (defined as MRI-PDFF ≥ 5%) and advanced fibrosis (defined as MRE ≥ 3.6 kPa) was 65% and 7.1%, respectively. One patient with advanced fibrosis had definite hepatocellular carcinoma. When compared to those without NAFLD, patients with NAFLD were younger (p=0.028) and had higher mean BMI (p=0.0008), waist circumference (p<0.0001) and prevalence of metabolic syndrome (84.6% vs. 40.0%, p<0.0001). Only 26% of those with NAFLD had elevated ALT. This proof-of-concept study demonstrates that T2DM has significant rates of both NAFLD and advanced fibrosis. Concomitant screening for NAFLD and advanced fibrosis by using MRI-PDFF and MRE in T2DM is feasible and may be considered after validation in a larger cohort.