LIVER FIBROSIS AND STEATOSIS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: A TRANSIENT ELASTOGRAPHY STUDY

Background :The prevalence of non-alcoholic fatty liver disease is notably high among patients with type 2 diabetes mellitus (T2DM). The objective of this study was to assess the potential utility of transient elastography (TE), a technique capable of measuring both fibrosis and liver fat content simultaneously, as a screening tool for hepatic involvement in patients with T2DM. Material and methods : Its a retrospective study spanned from January 2019 to January 2024 and included all patients diagnosed with T2DM who underwent TE. LSM values were determined using a Fibroscan 502 touch (Echosens SA, Paris, France) with the original M or XL probe selected based on the patients body weight or subcutaneous adipose tissue thickness, as per the manufacturers guidelines. TE scans were considered reliable when a minimum of 10 successful acquisitions were obtained, and the interquartile range-to-median ratio of the 10 acquisitions was ≤0.3. Results : A total of 124 patients with T2DM who underwent TE examination were included. 46 males and 78 females. The mean BMI of the patients was 33.2±6.6 kg/m2. The mean LSM was 7.1±3.4 kPa. LSM values exhibited significant correlations with BMI (p<0.001) and AST (p<0.001). The mean CAP value was 317±54 dB/m. Univariate correlation analyses demonstrated significant associations between CAP values and BMI (p<0.001). We found higher ALT levels (p<0.05) in patients with F3/F4 fibrosis. Both patients with mild and severe steatosis had higher ALT levels than those without (both p<0.05). However, ALT values did not differ significantly according to steatosis severity (p=0.69). Conclusion : Our results contribute to the existing body of evidence across various studies, approving the clinical utility of LSM and CAP for concurrent screening of liver fibrosis and steatosis in patients with T2DM.

【背景】2型糖尿病（type 2 diabetes mellitus, T2DM）患者中非酒精性脂肪性肝病的患病率显著偏高。本研究旨在评估瞬时弹性成像（transient elastography, TE）这一可同时检测肝纤维化与肝脏脂肪含量的技术，用于筛查2型糖尿病患者肝脏受累情况的潜在应用价值。
【材料与方法】本研究为回顾性研究，时间跨度为2019年1月至2024年1月，纳入所有确诊为2型糖尿病且接受瞬时弹性成像检查的患者。采用法国巴黎Echosens公司生产的Fibroscan 502 touch设备检测肝脏硬度值（liver stiffness measurement, LSM），根据制造商指南，按照患者体重或皮下脂肪厚度选择原配M型或XL型探头。当成功采集至少10次有效数据，且10次采集的四分位间距与中位数之比≤0.3时，视为瞬时弹性成像扫描结果可靠。
【结果】本研究共纳入124例接受瞬时弹性成像检查的2型糖尿病患者，其中男性46例，女性78例。患者的平均体质量指数（body mass index, BMI）为33.2±6.6 kg/m²，平均肝脏硬度值为7.1±3.4 kPa。肝脏硬度值与体质量指数（p<0.001）及天冬氨酸氨基转移酶（aspartate aminotransferase, AST）（p<0.001）均存在显著相关性。患者的平均受控衰减参数（controlled attenuation parameter, CAP）为317±54 dB/m，单变量相关分析显示受控衰减参数与体质量指数存在显著关联（p<0.001）。本研究发现，F3/F4期纤维化患者的丙氨酸氨基转移酶（alanine aminotransferase, ALT）水平更高（p<0.05）；轻度与重度脂肪变性患者的丙氨酸氨基转移酶水平均显著高于无脂肪变性患者（均p<0.05），但丙氨酸氨基转移酶水平与脂肪变性严重程度无显著差异（p=0.69）。
【结论】本研究结果为多项相关研究的现有证据体系提供了补充，证实了肝脏硬度值与受控衰减参数可用于同步筛查2型糖尿病患者的肝纤维化与脂肪变性，具备临床应用价值。