目的：应用FibroTouch技术评价2型糖尿病（T2DM）患者肝脏脂肪变和纤维化程度及二者相关性。方法：将92例T2DM患者按病程分为两组：病程>10年（A组）46例；病程≤10年（B组）46例，正常对照组（C组）46例。应用FibroTouch技术对肝脏脂肪衰减参数和肝脏硬度值进行检测，获得肝脏脂肪衰减参数和肝脏硬度值。结果：A组和B组肝脏脂肪衰减参数和肝脏硬度值均明显大于C组（P均<0.05）；A组肝脏脂肪衰减参数小于B组（P<0.05）；A组肝脏硬度值大于B组（P<0.05）。A组、B组脂肪衰减的程度较C组增加（P均＜0.05）；A组脂肪衰减的程度较B组减低（P＜0.05）；A组、B组肝脏硬度的程度较C组增加（P均＜0.05），A组肝脏硬度的程度较B组增加（P＜0.05）。T2DM患者肝脏脂肪变和纤维化程度之间呈明显负相关性（r=-0.81，P<0.05）。结论：FibroTouch技术可以无创、方便、客观地评价T2DM患者肝脏脂肪变和纤维化程度，具有重要的临床价值。
Abstract
Objective: To evaluate the extent of liver steatosis and fibrosis in patients of type 2 diabetes mellitus(T2DM) and correlation between liver steatosis and fibrosis by FibroTouch technique. Methods: Ninety-two cases of T2DM patients were enrolled and divided into group A(46 cases, diabetic duration>10 years) and group B(46 cases, diabetic duration≤10 years). Forty-six healthy subjects were enrolled as controls(group C). FibroTouch technique was used to measure the liver fat attenuation parameter(FAP) and liver stiffness measurement(LSM). Results: The FAP and LSM of group A and group B were significantly larger than those of group C(all of P<0.05); the FAP of group A was smaller than that of group B and the LSM of group A was larger than that of group B(all P<0.05). The degree of liver steatosis increased in group A and group B compared with that of group C(all of P<0.05)， and the degree of liver steatosis decreased in group A compared with that of group B(P<0.05); The degree of liver stiffness increased in group A and group B compared with that of group C (all of P<0.05), and the degree of liver stiffness increased in group A compared with that of group B(P<0.05). There was a negative correlation between liver fibrosis and steatosis(r=-0.81, P<0.05). Conclusion: The fibrosis and steatosis of the liver in T2DM patients can be evaluated non-invasively, conveniently and objectively by FibroTouch technique, which has an important clinical value.
关键词
脂肪肝 /
肝硬化 /
糖尿病 /
2型 /
超声检查 /
多普勒 /
彩色
Key words
Fatty liver /
Liver cirrhosis /
Diabetes mellitus, type 2 /
Ultrasonography, Doppler, color
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1]Sporea I, Mare R, Lupusoru R, et al. Liver Stiffness Evaluation by Transient Elastography in Type 2 Diabetes Mellitus Patients with Ultrasound-proven Steatosis[J]. J Gastrointest Liver Dis, 2016, 25(2): 167-174.
[2]Kitade H, Chen GL, Ni Y, et al. Nonalcoholic Fatty Liver Disease and Insulin Resistance: New Insights and Potential New Treatments[J]. Nutrients, 2017, 9(4): 387.
[3]张林杉，卞华，颜红梅，等. 2型糖尿病患者肝脏脂肪含量与肝病结局的相关性研究[J]. 中华内分泌代谢杂志，2014, 30(1): 3-7.
[4]温博，王炳元，李静波，等. FibroTouch与超声诊断脂肪肝一致性分析[J]. 中国肝脏病杂志，2016，8（2）：19-23.
[5]Wieckowska A, Feldstein AE. Diagnosis of nonalcoholic fatty liver disease: invasive versus noninvasive[J]. Semin Liver Dis, 2008, 8(4): 386-395.
[6]Day CP, James OF. Steatohepatitis: a tale of two "hits"?[J]. Gastroenterology, 1998, 114(4): 842-845.
[7]Rich N, Singal AG. Nonalcoholic Fatty Liver Disease-Related Hepatocellular Carcinoma: A Potential New Challenge for Hepatocellular Carcinoma Surveillance[J]. Gastroenterology, 2016, 151(6): 1246-1248.
[8]亓民. 研究分析肝脏硬度测定仪FibroTouch与FibroScan与肝脏病理分期的相关性[J]. 中国医药科学，2016，6（21）：218-220.
[9]Kotronen A, Westerbacka J, Berghol R, et al. Liver fat in the metatolic syndrome[J]. J Clin Endocrinol Metab, 2007, 92(9): 3490-3497.
[10]Juurinen L, Tiikkainen M, H?覿kkinen AM, et al. Effects of insulin therapy on liver fat content and hepatic insulin sensitivity in patients with type 2 diabetes[J]. Am J Physiol Endocrinol Metab, 2007, 292(3): e829-e835.
[11]Masuoka HC, Chalasani N. Nonalcoholic fatty liver disease: an emerging threat to obese and diabetic individuals[J]. Ann N Y Acad Sci, 2013, 1281: 106-122．
[12]Angulo P, Keach JC, Batts KP, et al. Independent Predictors of Liver Fibrosis in Patients With Nonalcoholic Steatohepatitis[J]. Hepatology, 1999, 30(6): 1356-1362.
[13]王家（马龙），李绍白. 肝脏病学[M]. 3版. 北京：人民卫生出版社，2013：58.
