Association Between Fatty Liver Disease State And Hepatic Advanced Fibrosis In Type 2 Diabetes

Objective:This study was designed to estimate the risk factors of non-alcoholic fatty liver disease (NAFLD) and advanced fibrosis in hospitalized patients with type 2 diabetes by application of NAFLD Fibrosis Score (NFS).Methods:A collection about the patients in hospitalized type 2 diabetes who were recruited from the department of endocrinology, diagnose NAFLD by ultrasound quantitative fatty liver,in First affiliated hospital of guangxi medical university, between April 2014 to February 2015. The history information,demographic information,past medical history,the body parameters, biochemical indicators and quantitative content of fatty liver ultrasound results, calculate body mass index (BMI) and NAFLD fibrosis score (NFS). After excluding alcohol, drugs and other systemic diseases that may cause fatty liver, a total of 131 subjects with type 2 diabetes were included in final analysis.Results:1.There were 131 subjects(male/female,45/86)diagnosed of NAFLD by ultrasound. In these patients, we used the low cutoff score (-1.455) of NFS to exclude and high cutoff score (0.676) to further accurately diagnose advanced fibrosis. There were 11 patients with advanced fibrosis (8.4%),43patients without advanced fibrosis (32.8%), and 77 patients (58.8%) with NFS between-1.455 and 0.676.2.The rise of age, BMI, AST/ALT ratio and reduce of albumin, platelet were risk factors for advanced fibrosis of NAFLD. In addition, with the increase of NFS, the duration of diabetes, waist circumference, BUN showed an increasing trend(P<0.05); while the decreasing trend was showed in Content of fatty liver and (P<0.05).TG in advanced fibrosis is greater than the group of no fibrosis (P< 0.05);ALP in the group of advanced fibrosis below the group of no fibrosis(P< 0.05).3.Spearman correlation analysis found that the NFS score with a linear positive correlation duration of diabetes duration, waist circumference and BUN;with significant negative correlation of diastolic blood pressure, TP, GGT, ALP, BUN and Ccr.4.Multiple factors analysis showed that waist circumference and advanced liver fibrosis are related (OR=1.048,P<0.05), ALP is negatively related to the advanced liver fibrosis (OR= 0.977, P< 0.05).Results:1. According to the NFS score, the prevalence of advanced fibrosis of he patients with NAFLD andT2DM was 8.4%,in First affiliated hospital of guangxi medical university, between April 2014 to February 2015.Although the prevalence is lower than the developed regions such as Shanghai, clinicians should be alert to the the risk of liver fibrosis in patients with type 2 diabetes and NAFLD.2. Abdominal obesity is a risk factor for advanced fibrosis in the patients with T2DM and NAFLD.Lifestyle intervention,reduced waist circumference is particularly important in patients with T2DM with NAFLD.3. The sample size of this study can’t enough to explain the correlation between ALP and advanced fibrosis in patients with T2DM and NAFLD,whether the ALP is the protection factors of advanced fibrosis remains to be further sample size and the prospective study.