慢性血液透析治疗的糖尿病患者的非酒精性脂肪性肝病-心血管和死亡风险的病例系列

Roxana Adriana Stoica, Laura Carina Tribus, Raluca Ioana Marin, Tara David, Carmen Monica Preda, Ioana Cristina Bica, Cristian Serafinceanu
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摘要

非酒精性脂肪性肝病(NAFLD)在糖尿病患者心血管疾病的发病机制中起重要作用,在终末期肾病(ESRD)患者中非常普遍。本病例系列描述了接受血液透析治疗的ESRD的2型糖尿病患者(T2DM)的NAFLD相关因素和生存率。T2DM和ESRD患者的NAFLD患病率为69.2%。大量患者(18人中有15人)通过计算身体质量指数(BMI)和生物阻抗测量来评估肥胖。NAFLD患者心血管死亡风险较高,18例患者中有13例已诊断为冠心病,6例已诊断为脑血管疾病,6例已诊断为外周动脉疾病。14例患者接受胰岛素治疗,2例患者接受西格列汀治疗(肾调节剂量25mg/天),2例患者接受药物营养治疗,HbA1c范围为4.4 - 9.0%。经过一年的随访,18例患者中有7例死亡,原因大致相同:心肌梗死、SARS-CoV2感染和肺水肿。总之,我们的2型糖尿病血液透析合并ESRD患者超声诊断为NAFLD的患病率为69.2%。此外,在一年的随访中,这一人群的死亡率很高,心血管原因是最常见的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Non-alcoholic fatty liver disease in diabetes mellitus patients on chronic hemodialysis - A case series addressing cardiovascular and mortality risks.

Non-alcoholic fatty liver disease (NAFLD) has an important role in the pathogenesis of cardiovascular diseases in the population with diabetes and it is highly prevalent in end-stage renal disease (ESRD) patients. This case series describes NAFLD associated factors and survival in type 2 diabetes patients (T2DM) who have ESRD treated with hemodialysis. NAFLD prevalence in patients with T2DM and ESRD is 69.2%. A high number of patients (15 out of 18) have obesity evaluated by calculating body mass index (BMI) and bioimpedance measurements. Patients with NAFLD have higher cardiovascular mortality risk, 13 of 18 patients were already diagnosed with coronary heart disease, 6 of 18 had cerebrovascular disease, and 6 of 18 had peripheral artery disease. Fourteen patients were treated with insulin, two patients with sitagliptin (renal adjusted dose of 25mg/day) and two patients with medical nutrition therapy, with an HbA1c ranging from 4.4 to 9.0%. After one-year follow-up 7 of 18 patients died, the causes having roughly equal proportions: myocardial infarction, SARS-CoV2 infection, and pulmonary edema. In conclusion, our population of type 2 diabetic patients with ESRD in hemodialysis had a prevalence of ultrasound-diagnosed NAFLD of 69.2%. Also, this population had a high death rate at one-year follow-up, cardiovascular causes being among the most common.

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