A prospective study on the prevalence of NAFLD, advanced fibrosis, cirrhosis and hepatocellular carcinoma in people with type 2 diabetes
A prospective study on the prevalence of NAFLD, advanced fibrosis, cirrhosis and hepatocellular carcinoma in people with type 2 diabetes
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DOI：
10.1016/j.jhep.2022.11.010
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发表时间：
2023-02-22
影响因子：
25.7
通讯作者：
Loomba, Rohit
中科院分区：
文献类型：
--
作者：
Ajmera, Veeral;Cepin, Sandra;Loomba, Rohit
背景和目标：关于专门入组并系统评估非酒精性脂肪肝（NAFLD）所致晚期纤维化或肝硬化的2型糖尿病（T2 DM）患者的前瞻性数据有限。因此，我们的目的是在前瞻性招募的T2 DM成人队列中评估晚期纤维化和肝硬化的患病率。方法：这项前瞻性研究招募了年龄>-50岁的T2 DM成人，从初级保健或内分泌诊所招募。参与者接受了标准化的临床研究访视，包括MRI-质子密度脂肪分数（MRI-PDFF）、磁共振弹性成像（MRE）、振动控制瞬态弹性成像（VCTE）和受控衰减参数。在排除其他肝脏疾病后，NAFLD定义为MRI-PDFF >-5%。晚期纤维化和肝硬化的定义，建立肝硬度截止点MRE或VCTE，如果MRE是unavailable.Results：524例患者筛选，501例成人（63%女性）与T2 DM符合资格。平均年龄和BMI分别为64.6（+/- 8.1）岁和31.4（+/- 5.9）kg/m2。NAFLD、晚期纤维化和肝硬化的患病率分别为65%、14%和6%。在多变量校正模型中，校正了年龄和性别，肥胖和胰岛素使用与晚期纤维化的几率增加相关（分别为比值比2.50; 95%CI 1.38-4.54; p = 0.003和比值比2.71; 95%CI 1.33-5.50; p = 0.006）。在29例肝硬化患者中，2例发现有肝细胞癌，1例胆囊腺癌。结论：利用一个独特的良好的表型前瞻性队列的患者年龄>-50岁的T2 DM，我们发现，先进的纤维化的患病率为14%，肝硬化为6%。这些数据强调了年龄>-50岁的T2 DM成人中晚期纤维化/肝硬化的高风险。(c)2022由Elsevier B. V.代表欧洲肝脏研究协会发表。
Background & Aims: There are limited prospective data on patients with type 2 diabetes mellitus (T2DM) specifically enrolled and systematically assessed for advanced fibrosis or cirrhosis due to non-alcoholic fatty liver disease (NAFLD). Therefore, we aimed to evaluate the prevalence of advanced fibrosis and cirrhosis in a prospectively recruited cohort of adults with T2DM.Methods: This prospective study enrolled adults aged >-50 years with T2DM, recruited from primary care or endocrinology clinics. Participants underwent a standardized clinical research visit with MRI-proton density fat fraction (MRI-PDFF), magnetic resonance elastography (MRE), vibration-controlled transient elastography (VCTE) and controlled-attenuation parameter. NAFLD was defined as MRI-PDFF >-5% after exclusion of other liver diseases. Advanced fibrosis and cirrhosis were defined by established liver stiffness cut-off points on MRE or VCTE if MRE was not available.Results: Of 524 patients screened, 501 adults (63% female) with T2DM met eligibility. The mean age and BMI were 64.6 (+/- 8.1) years and 31.4 (+/- 5.9) kg/m2, respectively. The prevalence of NAFLD, advanced fibrosis and cirrhosis was 65%, 14% and 6%, respectively. In multivariable adjusted models, adjusted for age and sex, obesity and insulin use were associated with increased odds of advanced fibrosis (odds ratio 2.50; 95% CI 1.38-4.54; p = 0.003 and odds ratio 2.71; 95% CI 1.33-5.50; p = 0.006, respectively). Among 29 patients with cirrhosis, two were found to have hepatocellular carcinoma and one patient had gall-bladder adenocarcinoma.Conclusion: Utilizing a uniquely well-phenotyped prospective cohort of patients aged >-50 years with T2DM, we found that the prevalence of advanced fibrosis was 14% and that of cirrhosis was 6%. These data underscore the high risk of advanced fibrosis/ cirrhosis in adults aged >-50 years with T2DM.(c) 2022 Published by Elsevier B.V. on behalf of European Association for the Study of the Liver.