合并2型糖尿病的非酒精性脂肪性肝病临床病理特征分析

Clinical and pathological characterjstics of nonalcoholic fatty liver disease with type 2 diabetes

目的探讨合并2型糖尿病的非酒精性脂肪性肝病(NAFLD)患者的临床及病理特征。方法采用回顾性研究方法,选取2014年1月至2018年5月于首都医科大学附属北京友谊医院经肝组织穿刺术病理诊断为NAFLD的患者84例,按照是否合并2型糖尿病分为糖尿病组(30例)和非糖尿病组(53例)。收集并比较两组患者的临床特征、实验室指标、影像学检查和病理学特征。结果与非糖尿病组比较,糖尿病组NAFLD患者的平均年龄更高(53.6±10.3岁vs.43.7±14.9岁,P=0.002)、女性患者比率更高(90.0%vs.55.6%,P=0.001),合并高血压(50.0%vs.24.1%,P=0.038)、代谢综合征(76.7%vs.29.6%,P<0.001)的比率更高。两组患者的实验室检查比较,糖尿病组患者的血清丙氨酸氨基转移酶、球蛋白、空腹血糖、糖化血红蛋白和肌酐水平均显著高于非糖尿病组(P<0.05);而血红蛋白水平和凝血酶原活动度水平显著低于非糖尿病组(P<0.05)。肝脏病理学特征比较,糖尿病组患者的纤维化分期(2.8±1.2 vs.1.7±1.2),P<0.001、进展期纤维化患者比率[19/30(63.3%)vs.16/54(29.6%),P=0.005]均显著高于非糖尿病组。相应地,肝脏硬度检测提示糖尿病组患者的肝脏硬度值较非糖尿病组显著升高(中位数:14.0k Pa vs.8.8 k Pa,P=0.004)。结论与未合并2型糖尿病的NAFLD患者相比,合并2型糖尿病的NAFLD患者临床病理表现更重,对此类患者应密切监测,必要时应及时行肝组织穿刺术病理检查以评估病情。

Objective To analyze the clinical and pathological features of nonalcoholic fatty liver disease(NAFLD)in patients with type2 diabetes.Methods A retrospective analysis was performed among 84 patients with biopsy proven NAFLD who were hospitalized in Beijing Friendship Hospital from January 2014 to May 2018.The patients were divided into diabetes group(30 cases)and non-diabetic group(53 cases)according to whether they were accompanied with type 2 diabetes.Their clinical,biochemical,radiological and pathological characteristics were collected and compared.Results Compared with non-diabetes group,patients in diabetes group had higher average age(53.6±10.3 y vs.43.7±14.9 y,P=0.002),higher proportion of females(90.0%vs.55.6%,P=0.001),and higher proportion of hypertension(50.0%vs.24.1%,P=0.038)and metabolic syndrome(76.7%vs.29.6%,P<0.001).Diabetes group also had higher levels of serum alanine transaminase(ALT),globulin,fasting glucose,Hb A1 c and creatinine,but lower levels of hemoglobin and prothrombin time activity(P<0.05).Histologically,diabetes group had more severe liver fibrosis stage[(2.8±1.2 vs.1.7±1.2),P<0.001]and a significant higher prevalence of advanced fibrosis[19/30(63.3%)vs.16/54(29.6%),P=0.005].In addition,values of liver stiffness measurement were also significantly higher in diabetes group than those in non-diabetes group(median 14.0 kPa vs.8.8 kPa,P=0.004).Conclusion NAFLD patients with type 2 diabetes tend to present with more severe clinical and histological features compared with those without type 2 diabetes.It is necessary to screen and monitor liver fibrosis in such patients,and if necessary,liver biopsy should be performed in time to evaluate the severity of the disease.