2型糖尿病患者非酒精性脂肪性肝病评分的基线值及其风险评估

Kalpesh Joshi, S. Chandrakar, Smita V. Patil
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摘要

在印度,非酒精性脂肪性肝病(NAFLD)的患病率正在上升,并受到肥胖和糖尿病双重流行的推动。该研究的目的是评估各种非侵入性NAFLD评分(NINS),用于2型糖尿病(T2DM)患者NAFLD的基线风险评估。方法:对研究者评定的NINS进行观察性、横断面、开放标签研究,确保遵守相关伦理标准。结果:在3个月的时间里,29例T2DM患者入组(年龄[mean±SD]: 55.8±9.72岁;男性[n, %]: 18.62%)。纤维化-4指数(晚期纤维化≥2.67)和AST /血小板比值指数(≥0.98)1例(3.45%);2例(6.90%)NAFLD纤维化评分(截止值≥0.676);体重指数(BMI)、AST / ALT比值和DM评分(BARD;cuff-off≥2);BMI、年龄、ALT、甘油三酯评分(截止值≥1)提示晚期肝纤维化高危者27例(93.10%)。只有BARD得分(中位数[min-max]: 3[1-4])高于临界值,其他得分低于临界值。该研究未能证明年龄、性别、人体测量和代谢参数与NINS之间存在任何相关性。结论:虽然本研究未发现NINS显著升高,但在一些T2DM患者中发现NINS评分升高,他们可能处于晚期肝纤维化的高风险中。需要在这一领域进行进一步精心设计的研究,以便及早发现、管理和减轻印度糖尿病患者肝脏疾病的负担。
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Baseline Values of Nonalcoholic Fatty Liver Disease Scores and Its Risk Assessment in Patients with Type 2 Diabetes Mellitus
Introduction: The prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing and is fueled by a twin-epidemic of obesity and diabetes mellitus in India. The objective of the study was to estimate various noninvasive NAFLD scores (NINS) for the baseline risk-assessment of NAFLD in patients with type 2 diabetes mellitus (T2DM). Methods: An observational, cross-sectional, open label, study of investigator-rated NINS was conducted ensuring adherence to relevant ethical standards. Results: In a 3-month period, 29 patients with T2DM were enrolled (age [mean ± SD]: 55.8 ± 9.72 years; men [n, %]: 18, 62%). One patient (3.45%) by fibrosis-4 index (cutoff for advanced fibrosis ≥2.67) and by AST to platelet ratio index (cutoff ≥0.98); 2 (6.90%) by NAFLD fibrosis score (cutoff ≥0.676); 20 (69%) by body mass index (BMI), AST to ALT ratio, and DM score (BARD; cuff-off ≥2); and 27 (93.10%) by BMI, age, ALT, triglyceride score (cutoff ≥1) indicated high risk for advanced hepatic fibrosis. Only the BARD score (median [min-max]: 3 [1–4]) was elevated above the cutoff values while other scores were below cutoff values. The study failed to demonstrate any correlation between age, gender, anthropometric and metabolic parameters, and NINS. Conclusion: While this study did not demonstrate significant elevation of NINS, scores were found be elevated in some T2DM patients and they may be at high risk of advanced liver fibrosis. Further well-designed studies in this domain are required for early detection, management, and reducing the burden of liver disease in Indian patients with diabetes.
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