Screening diabetic patients for non-alcoholic fatty liver disease with controlled attenuation parameter and liver stiffness measurements: a prospective cohort study

被引:403
作者
Kwok, Raymond [1 ,2 ]
Choi, Kai Chow [3 ]
Wong, Grace Lai-Hung [1 ,2 ,4 ]
Zhang, Yuying [1 ]
Chan, Henry Lik-Yuen [1 ,2 ,4 ]
Luk, Andrea On-Yan [1 ]
Shu, Sally She-Ting [1 ,2 ,4 ]
Chan, Anthony Wing-Hung [5 ]
Yeung, Ming-Wai [1 ]
Chan, Juliana Chung-Ngor [1 ]
Kong, Alice Pik-Shan [1 ]
Wong, Vincent Wai-Sun [1 ,2 ,4 ]
机构
[1] Chinese Univ Hong Kong, Dept Med & Therapeut, Shatin, Hong Kong, Peoples R China
[2] Chinese Univ Hong Kong, Inst Digest Dis, Shatin, Hong Kong, Peoples R China
[3] Chinese Univ Hong Kong, Nethersole Sch Nursing, Shatin, Hong Kong, Peoples R China
[4] Chinese Univ Hong Kong, State Key Lab Digest Dis, Shatin, Hong Kong, Peoples R China
[5] Chinese Univ Hong Kong, Dept Anat & Cellular Pathol, Shatin, Hong Kong, Peoples R China
关键词
RISK-FACTORS; TRANSIENT ELASTOGRAPHY; HEPATIC-FIBROSIS; CHINESE PATIENTS; PREVALENCE; DIAGNOSIS; POPULATION; CIRRHOSIS; STEATOHEPATITIS; ASSOCIATION;
D O I
10.1136/gutjnl-2015-309265
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Objective Type 2 diabetes is an important risk factor for non-alcoholic fatty liver disease (NAFLD), but current guidelines provide conflicting recommendations on whether diabetic patients should be screened for NAFLD. We therefore studied the strategy of screening diabetic patients by FibroScan. Design Liver fat and fibrosis were assessed by controlled attenuation parameter (CAP) and liver stiffness measurements (LSM) by FibroScan at a diabetic centre for patients from primary care and hospital clinics. Probe-specific LSM cut-offs were used to detect advanced fibrosis. Results Of 1918 patients examined, 1799 (93.8%) had valid CAP and 1884 (98.2%) had reliable LSM (1770 with the M probe and 114 with the XL probe). The proportion of patients with increased CAP and LSM was 72.8% (95% CI 70.7% to 74.8%) and 17.7% (95% CI 16.0% to 19.5%), respectively. By multivariable analysis, female gender, higher body mass index, triglycerides, fasting plasma glucose and alanine aminotransferase (ALT) and non-insulin use were associated with increased CAP. Longer duration of diabetes, higher body mass index, increased ALT and spot urine albumin: creatinine ratio and lower high-density lipoprotein-cholesterol were associated with increased LSM. Ninety-four patients (80% had increased LSM) underwent liver biopsy: 56% had steatohepatitis and 50% had F3-4 disease. Conclusions Diabetic patients have a high prevalence of NAFLD and advanced fibrosis. Those with obesity and dyslipidaemia are at particularly high risk and may be the target for liver assessment. Our data support screening for NAFLD and/or advanced fibrosis in patients with type 2 diabetes.
引用
收藏
页码:1359 / 1368
页数:10
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