| Objective:This study was designed to estimate the prevalence of non-alcoholic fatty liver disease (NAFLD) and advanced fibrosis in hospitalized patients with type2diabetes by application of NAFLD Fibrosis Score (NFS), and preliminarily analysed the risk factors associated with advanced fibrosis in type2diabetes.Methods:A cross-sectional survey was performed in hospitalized type2diabetes who were recruited from the department of endocrinology, Zhongshan hospital Fudan University, between September2009and January2013. The history information, demographic information, past history, anthropometric parameters, biochemical parameters and liver ultrasound were collected in all subjects to calculate body mass index (BMI) and NAFLD fibrosis score (NFS). After excluding alcohol, drugs and other systemic diseases that may cause fatty liver, a total of1413subjects with type2diabetes were included in final analysis.Results:1. There were1238patients with T2DM receiving liver ultrasonography screening, and the detection rate of NAFLD was58.2%; The detection rate of NAFLD was58.5%in male,57.9%in female. There was no significant difference of detection rate of NAFLD between different gender (χ2=0.041, P>0.05).2. There were721subjects diagnosed of NAFLD by ultrasound. In these patients, we used the low cutoff score (-1.455) of NFS to exclude and high cutoff score (0.676) to further accurately diagnose advanced fibrosis. There were173patients with advanced fibrosis (24.0%),111patients without advanced fibrosis (15.4%), and437patients (60.6%) with NFS between-1.455and0.676.3. The rise of age, BMI, AST/ALT ratio and reduce of albumin, platelet were risk factors for advanced fibrosis of NAFLD. In addition, with the increase of NFS, the duration of diabetes, waist circumference, waist-hip ratio, systolic blood pressure, percentage of neutrophils and glycated albumin showed an increasing trend; while the decreasing trend was showed in RBC, Hb, WBC, TC, TG, APO-B, ALT, AST and y-GT. Spearman correlation analysis showed that NFS was positively correlated with duration of diabetes (P<0.01).Conclusion:The detection rate of advanced fibrosis in patients with NAFLD and T2DM was approximately24.0%by applying NAFLD Fibrosis Score. The proportion of subjects who can be excluded from advanced fibrosis was only15.4%. It suggest that we should be alert to the the risk of liver fibrosis in patients with type2diabetes. Objective:This study was designed to explore the association between the liver fat content and metabolic status in type2diabetes along with the adverse liver disease outcome and analyse the influencing factors.Methods:A cross-sectional survey was performed in hospitalized type2diabetes who were recruited from the department of endocrinology, Zhongshan hospital Fudan University, between September2009and January2013. The history information, demographic information, past history, anthropometric parameters, biochemical parameters, liver ultrasound and hepatic1H-MRS were collected in all subjects to calculate body mass index (BMI), liver fat content (LFC) and several non-invasive fibrosis scoring systems. After excluding alcohol, drugs and other systemic diseases that may cause fatty liver, a total of435subjects with type2diabetes were included in final analysis.Results:1. There were82(18.9%) diagnosed type2diabetic patients (NT2DM), and353(81.1%) previously diagnosed (PT2DM) in435T2DM patients. The detection rate of NAFLD in NT2DM group is higher than PT2DM group. After adjustment for gender, age, blood glucose, blood lipid, oral hypoglycemic drugs, the LFC of NT2DM patients is significantly higher than that of PT2DM group (P<0.05). The FBG, HbA1c, GA, LDL-C, ALT and γ-GT in NT2DM were significantly higher than that of PT2DM(P<0.05).2. To analyse the effect of antidiabetic drugs for liver fat content in PT2DM, it was showed that in PT2DM, sulfonylurea, alpha-glucosidase inhibitors, and significantly decreased the LFC (P<0.05), while there were no effects of insulin-sensitizing drugs (metformin and TZDs) on liver fat content (P>0.05). Covariance analysis showed that after adjustment for gender, BMI, duration of diabetes and other antidiabetic drugs, only alpha-glucosidase inhibitors (F=5.328, P=0.021) and insulin (F=6.457, P=0.011) can significantly reduce the liver fat content (P<0.05).3. According to tertile of liver fat content, one-way ANOVA showed that patients with smaller ages, shorter duration of diabetes, higher BMI and waist circumference have higher liver fat content. With the rise of LFC, diastolic blood pressure, RBC, Hb, FCP, FINS, TG, APO-E, Alb, ALT, AST, γ-GT, UA and CRP showed an increasing trend; and HDL-C decreased (P<0.05). Partial correlation analysis showed that LFC was negatively correlated with duration of diabetes (rs=-0.233, P<0.01) after adjustment for gender, age, BMI, oral anti-diabetic drugs, insulin treatment and lipid-lowering drugs. Multiple linear regression analysis showed that LFC had positive linear correlation with BMI, albumin and ALT, while and negative correlated with duration of diabetes.4. There were366patients with NAFLD diagnosed by MRS (LFC≥5.56%),72cases of advanced fibrosis(NFS>0.676,19.7%),65cases without advanced fibrosis (NFS <-1.455,17.8%). The proportion of patients without advanced fibrosis in NT2DM was significantly higher than that in PT2DM (26.3%vs15.5%, χ2=4-808, P<0.05); The proportion of PT2DM in patients with advanced fibrosis(NFS>0.676) was79.2%, and the proportion of NT2DM was only20.8%(χ2=5.093, P<0.05).5. Among NAFLD patients diagnosed by MRS, the liver fat content in patients with advanced liver fibrosis (NFS>0.676) was significantly lower than those without advanced fibrosis (NFS<-1.455)(P<0.05). And the LFC was negatively correlated with non-invasive fibrosis score including NFS, AST/ALT ratio and BARD score.Conclusion:The increase of liver fat content in type2diabetes exacerbated glucose and lipid metabolism. alpha-glucosidase inhibitors and insulin therapy had a certain role in the reduction of LFC. The duration of diabetes was an independent factor that impact liver fat content. The reduction of liver fat content is related to the development of advanced fibrosis according to the increase of diabetic duration in subjects with type2diabetes and NAFLD. Decline in liver fat content of type2diabetic patient is associated with poor outcome of non-alcoholic fatty liver disease. Objective:The purpose of this study is to analyze the association between liver fat content, liver enzyme levels, inflammatory markers, liver fibrosis and iron overload in hospitalized type2diabetes, and to explore the relationships between iron overload and insulin resistance, metabolic status and liver disease outcome in patients with type2diabetes.Methods:A cross-sectional survey was performed in hospitalized type2diabetes and patients that receiving liver biopsy who were recruited from the department of endocrinology, Zhongshan hospital Fudan University, between September2009and January2013. The history information, demographic information, past history, anthropometric parameters, iron metabolic parameters (including SF, TRF, SI, TIBC), biochemical parameters, liver ultrasound and hepatic H-MRS were collected in all subjects to calculate body mass index (BMI), liver fat content (LFC) and NAFLD fibrosis score. After excluding alcohol, drugs and other systemic diseases that may cause fatty liver, a total of530subjects with type2diabetes and18subjects who received liver biopsy were included in final analysis.Results:1. The iron loads in type2diabetic patients with NAFLD was significantly higher than those without NAFLD (SF:328.7±252.2vs239.9±171.8; SI:15.0±4.9vs13.3±5.3μmol/L; TRF:2.36±0.40vs2.18±0.40g/L; TIBC:46.7±6.2vs43.0±6.7μ mol/L; P<0.01). Logistic regression analysis showed that after adjustment for age, gender, BMI and other confounding factors, serum ferritin (OR=1.002,95%CI:1.001-1.003, P=0.004) and transferrin (OR=2.682,95%CI:1.320-5.447, P=0.006) were independent risk factors for NAFLD.2. The iron loads in patients with T2DM were positively correlated with liver fat content (P<0.05); Multiple linear regression analysis showed that after adjustment for sex, age and duration of diabetes, SF was still positively correlated with liver fat content.3. The serum ferritin of NAFLD accompanying elevated liver enzymes was significantly higher than that of simple steatosis (429.9±287.4vs293.4±233.3ng/ml, P<0.01); The concentration of serum ferritin in T2DM patients with NAFLD showed a significant positive correlation with ALT, AST and y-GT. Logistic regression analysis showed that serum ferritin was an independent risk factor (OR=1.003,95%CI:1.001-1.004,P<0.05) for NAFLD patients with elevated liver enzymes.4. The iron load of patients with advanced fibrosis (NFS>0.676) were significantly lower than that of those without advanced fibrosis (NFS<-1.455)(P<0.01). Partial correlation analysis showed that after adjustment for diabetic duration and liver fat content, iron load of NAFLD was negatively correlated with NAFLD fibrosis score.5. By evaluating the diagnostic value of the iron metabolic parameters for NAFLD and NAFLD associated with liver damage according to the receiver operator characteristic curve, TRF had the greatest diagnostic value for NAFLD in male. The optimal cutoff value of TRF is2.15g/L. Meanwhile, for NASH, serum ferritin was the greatest one, and the optimal cutoff value in male is249.0ng/ml,233.8ng/ml in female.6. There were18patients underwent liver biopsy, all the prussian blue iron stain were negative.13cases of NASH;2cases of NASH borderline;3cases of simple fatty liver.13subjects present fibrosis including7cases of advanced fibrosis. Partial correlation analysis showed that after adjustment for gender, serum ferritin had no significant correlated with NAS, steatosis, ballooning, foci necrosis and fibrosis stage, respectively. Student t test showed that serum ferritin of patients with biopsy proven NASH were slightly higher than that of patients with simple steatosis, and serum ferritin of patients with NASH presenting advanced fibrosis were much higher, but there was no statistically significant differences (P>0.05).Conclusion:The iron overload in type2diabetes is an independent risk factor for development of NAFLD. The concentration of ferritin in NAFLD with elevated liver enzymes was significantly higher than that of simple fatty liver, and serum ferritin was an independent risk factor for NAFLD patients with elevated liver enzymes. Iron load of patients with advanced fibrosis according to the NAFLD fibrosis score were significantly decreased. |
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