Changes of fat controlled attenuation parameter and liver stiffness measurement in patients with nonalcoholic fatty liver disease complicated with type 2 diabetes mellitus

Abstract

Abstract: Objective To explore the changes of liver fat controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) in patients with nonalcoholic fatty liver disease(NAFLD) complicated with type 2 diabetes mellitus (T2DM), and to provide clinical basis for early NAFLD screening of diabetic patients.Methods From January 2018 to December 2020, 128 patients with T2DM (58 males and 70 females) were reviewed, with age of (52.6±8.2) years. The diagnosis of NAFLD and T2DM was in line with the guidelines, and the patients with T2DM were divided into NAFLD group and single T2DM group according to whether they were complicated with NAFLD. T test was used for measurement data, and Chi-square test was used for counting data.Results There were 44 cases and 84 cases in NAFLD group and single T2DM group in 128 patients with T2DM. Comparative data showed that ALT, AST, TG, LDL, FBG, FINS and HbA1c in NAFLD group were (86.3±10.5) U/L, (82.9±8.3) U/L, (2.5±0.7) mmol/L, (4.4±1.3) mmol/L, (9.6±1.2) mmol/L, (5.2±1.5) uIU/uL and (8.4±0.9)%, compared with single T2DM group [(38.2±4.8) U/L, (39.7±3.8) U/L, (1.6±0.5) mmol/L, (2.3±0.8) mmol/L, (7.2±1.0) mmol/L, (3.6±1.1) uIU/uL and (6.9±0.8)%], the difference was statistically significant (P<0.05). The LSM of NAFLD group and single T2DM group were (9.3±2.4) kPa and (5.7±1.1) kPa, with statistical significance difference (P<0.05). The levels of CAP in NAFLD group and single T2DM group were (224.2±36.4) dB/m and (121.4±24.9)dB/m, with statistical significance difference (P<0.05). According to the degree of hepatic steatosis, it could be divided into Grade 0 to Grade 3 (G0-G3). In T2DM patients with NAFLD, there were 7 patients with G0, 14 with G1, 13 with G2, 10 with G3. The CAP values of G2 and G3 were significantly higher than those of G0 and G1 respectively (P<0.05), while the CAP values of G3 were significantly higher than those of G2 (P<0.05). According to the degree of liver fibrosis, it could be divided into F0 to F4. In T2DM patients with NAFLD, there were 6 patients with F0, 11 with F1, 13 with F2, 8 with F3, 6 with F4. LSM values in F3 and F4 were significantly higher than those in F0, F1 and F2 (P<0.05).Conclusion There is an obvious correlation between T2DM and NAFLD. Early screening of T2DM and NAFLD has a positive impact on the treatment and prognosis of the disease.

Key words: Nonalcoholic fatty liver disease, Type 2 diabetes mellitus, Controlled attenuation parameter, Liver stiffness measurement

WEI Jian-dong, GOU Xiao-jun, CHEN Yuan-zhuo, SHI Wei. Changes of fat controlled attenuation parameter and liver stiffness measurement in patients with nonalcoholic fatty liver disease complicated with type 2 diabetes mellitus[J]. Chinese Hepatolgy, 2022, 27(3): 355-357.

References

[1] Araújo AR, Rosso N, Bedogni G, et al. Global epidemiology of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis: What we need in the future. Liver Int, 2018, 38: 47-51.
[2] Cobbina E, Akhlaghi F. Non-alcoholic fatty liver disease (NAFLD)-pathogenesis, classi-cation, and elect on drug metabolizing enzymes and transporters. Drug Metab Rev, 2017,49: 197-211.
[3] Chalasani N,Younossi Z,Lavine JE,et al.The diagnosis and management of nonalcoholic fatty liver disease:practice guidance from the American Association for the Study of Liver Diseases.Hepatology,2018,67:328-357.
[4] Fang YL, Chen H, Wang CL,et al. Pathogenesis of non-alcoholic fatty liver disease in children and adolesce:from "two hit theory" to " multiple hit model" . World J Gastroenterol,2018,24:2974-2983.
[5] Mantovani A,Byrne CD,Bonora E,et al. Non alcoholic fatty liver disease and risk of incident type 2 diabetes:a meta-analysis. disbetes care,2018,41:372-382.
[6] 党超志,唐超燕. 非肥胖 2 型糖尿病与非酒精性脂肪性肝病相关性的Meta分析. 胃肠病学和肝病学杂志,2017,26:1128-1131.
[7] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版).中华糖尿病杂志,2018,10:4-67.
[8] 中华医学会肝病学分会脂肪肝和酒精性肝病学组,中国医师协会脂肪性肝病专家委员会.酒精性肝病防治指南(2018更新版). 中华肝脏病杂志,2018: 188-194.
[9] Liao R, Fu YP, Wang T, et al. Metavir and FIB-4 scores are associated with patient prognosis after curative hepatectomy in hepatitis B virus-related hepatocellular carcinoma:a retrospective cohort study at two centers in China. Oncotarget, 2017, 8: 1774-1781.
[10] American Diabetes Association. Classification and diagnosis of diabetes. Diabetes care,2017,40:S11-24.
[11] Dongiovanni P,stender S,Pietrelli A,et al. Causal relationship of hepatic fat with liver damage and insulin resistance in nonalcoholic fatty liver. J Intern Med,2018,283:356-370.
[12] Liu Z, zhang Y,Graham S, et al. Causal relationships between NAFLD,T2D and obesity have implications for disease subphenotyping. J Hepatol,2020,73:263-276.
[13] Younossi ZM,Golabi P,de Avila L,et al. The global epidemiology of NAFLD and NASH in patients with type 2 diabetes:a systematic review and meta-analysis. J Hepatol,2019,71:793-801.
[14] Mu W, Cheng XF, Liu Y, et al. Potential nexus of non-alcoholic fatty liver disease and type 2 diabetes mellitus:insulin resistance between hepatic and peripheral tissues. Front Pharmacol, 2019,9:1566.
[15] Karlas T, Petroff D, Sasso M, et al. Individual patient data meta-analysis of controlled attenuation parameter (CAP) technology for assessing steatosis. J Hepatol, 2017, 66:1022-1030.
[16] Vuille-Lessard ?, Lebouché B, Lennox L, et al. Nonalcoholic fatty liver disease diagnosed by transient elastography with controlled attenuation parameter in unselected HIV monoinfected patients. AIDS, 2016, 30:2635-2643.
[17] 冷雪君, 颜学兵.FibroTouch(R)对不同BMI水平非酒精性脂肪性肝病患者肝纤维化程度的评估比较.临床肝胆病杂志,2018,34:1891-1895.