Low prevalence of non‐alcoholic fatty liver disease in patients with type 1 diabetes is associated with decreased subclinical cardiovascular disease 在1型糖尿病患者中非酒精性脂肪性肝病的患病率较低与亚临床心血管疾病较少相关

• Published in: Journal of diabetes Vol. 9; no. 12; pp. 1065 - 1072
• Main Authors: Serra‐Planas, Enric, Aguilera, Eva, Castro, Laura, Rodríguez, Raúl, Salinas, Isabel, Lucas, Anna, Joaquín, Clara, Puig, Rocio, Mauricio, Dídac, Puig‐Domingo, Manel
• Format: Journal Article
• Language: English
• Published: 01.12.2017
• ISSN: 1753-0393; 1753-0407
• DOI: 10.1111/1753-0407.12539

Abstract Background Non‐alcoholic fatty liver disease ( NAFLD ) has been proposed as an independent cardiovascular risk factor. The present study evaluated the prevalence of NAFLD in a cohort of type 1 diabetic ( T1D ) patients and its potential relationship with subclinical cardiovascular disease ( CVD ). Methods One hundred T1D patients (mean [± SD ] age 39.4 ± 7.8 years, disease duration 21.7 ± 8.6 years) were included in the present cross‐sectional study. All subjects underwent abdominal ultrasonography for detection of NAFLD , carotid ultrasonography to measure the carotid intima–media thickness ( CIMT ) and atheroma plaques, and cardiac tomography for evaluation of the coronary artery calcium score ( CACS ). Results Of the study cohort, 12% had NAFLD and 23% had a CACS >0. The T1D subjects with NAFLD had a greater CIMT than those without NAFLD (0.65 ± 0.17 vs 0.55 ± 0.14 mm; P  = 0.029), but there were no significant differences between the two groups with regard to CACS , glycemic control, or the presence of carotid plaques. Patients with high liver enzyme concentrations (>20 U/L) had a higher CIMT (0.60 ± 0.16 vs 0.54 ± 0.13; P   =  0.04) and there was a higher proportion of altered CACS (17 [73.9%] vs 6 [26.1%]; P   =  0.001) and detection of carotid plaques (10 [76.9%] vs 3 [23.1%]; P   =  0.014) in this group. Conclusions A low prevalence of NAFLD was found in the T1D cohort that was associated globally with a low proportion of abnormal CVD imaging markers, although these imaging parameters were worse in subjects in whom NAFLD was detected. 摘要 背景 非酒精性脂肪性肝病(non‐alcoholic fatty liver disease,NAFLD)被认为是一个独立的心血管危险因素。本研究是在一个1型糖尿病患者队列中评估NAFLD的患病率以及它与亚临床心血管疾病(cardiovascular disease,CVD)之间的潜在关系。 方法 当前这项横断面研究纳入了100名1型糖尿病患者(平均年龄[± SD]为39.4 ± 7.8岁,病程为21.7 ± 8.6年)。对受试者进行腹部超声扫描以检测NAFLD,进行颈动脉超声检查以测量颈动脉内膜‐中膜厚度(carotid intima–media thickness,CIMT)和动脉粥样硬化斑块,进行心脏断层摄片评估冠状动脉钙化积分(coronary artery calcium score,CACS)。 结果 在这项队列研究中,12%的患者有NAFLD,23%的患者CACS > 0。合并NAFLD的1型糖尿病患者与不合并NAFLD的患者相比CIMT更厚(分别为0.65 ± 0.17与0.55 ± 0.14 mm; P = 0.029),但是两组之间在CACS、血糖控制或存在颈动脉斑块方面都没有显著性差异。肝酶水平较高(> 20 U/L)的患者,其CIMT更厚(分别为0.60 ± 0.16与0.54 ± 0.13; P = 0.04),并且这组患者出现CACS变化(分别为17 [73.9%]与6 [26.1%]; P = 0.001)以及出现颈动脉斑块(分别为10 [76.9%]与3 [23.1%]; P = 0.014)的比例更高。 结论 在1型糖尿病患者队列中发现NAFLD的患病率很低,并在总体上与较低比例的异常CVD影像标记物相关,虽然在检测出NAFLD的受试者中这些影像参数都更差。