2型糖尿病与非酒精性脂肪性肝病：关联与管理
Type 2 Diabetes Mellitus and Nonalcoholic Fatty Liver Disease: Correlation and Management
DOI: 10.12677/acm.2024.1482257, PDF,   
作者: 郭翠愿：暨南大学第一临床医学院，广东 广州；龚晓兵*：暨南大学附属第一医院全科医学科，广东 广州
关键词: 非酒精性脂肪性肝病；2型糖尿病；关联；管理；NAFLD； T2DM； Correlation； Management
摘要: 非酒精性脂肪性肝病(NAFLD)已成为全球范围内一个主要的公共卫生问题，同时也是最常见的慢性肝病，其患病率和发病率正迅速增加。尽管NAFLD在普通人群中相当普遍，但仅有少数NAFLD患者会进一步发展为非酒精性脂肪性肝炎(NASH)，并可能伴随晚期肝纤维化(即3~4期纤维化)和肝脏相关的并发症。值得注意的是，2型糖尿病患者被认为是罹患NASH和晚期纤维化的高风险人群。当前，医学指南建议对2型糖尿病患者进行NAFLD筛查，并评估其纤维化的风险。本文旨在阐述2型糖尿病与NAFLD之间的紧密联系，并探讨相关的管理方法。
Abstract: Nonalcoholic Fatty Liver Disease (NAFLD) has emerged as a major global public health issue and the most common chronic liver disease, with rapidly increasing prevalence and incidence. While NAFLD is prevalent in the general population, only a fraction of patients with NAFLD progress to nonalcoholic steatohepatitis (NASH), potentially accompanied by advanced liver fibrosis (stages 3~4 fibrosis) and liver-related complications. Notably, individuals with type 2 diabetes mellitus (T2DM) are considered to be at a high risk of developing NASH and advanced fibrosis. Current medical guidelines recommend screening for NAFLD in individuals with T2DM and assessing their risk of fibrosis. This article aims to elaborate on the close association between T2DM and NAFLD and explore relevant management approaches.
文章引用：郭翠愿, 龚晓兵. 2型糖尿病与非酒精性脂肪性肝病：关联与管理[J]. 临床医学进展, 2024, 14(8): 605-611. https://doi.org/10.12677/acm.2024.1482257

参考文献

[1] Younossi, Z.M., Koenig, A.B., Abdelatif, D., Fazel, Y., Henry, L. and Wymer, M. (2016) Global Epidemiology of Nonalcoholic Fatty Liver Disease—Meta-Analytic Assessment of Prevalence, Incidence, and Outcomes. Hepatology, 64, 73-84. [Google Scholar] [CrossRef] [PubMed]
[2] Angulo, P., Kleiner, D.E., Dam-Larsen, S., Adams, L.A., Bjornsson, E.S., Charatcharoenwitthaya, P., et al. (2015) Liver Fibrosis, but No Other Histologic Features, Is Associated with Long-Term Outcomes of Patients with Nonalcoholic Fatty Liver Disease. Gastroenterology, 149, 389-397.e10. [Google Scholar] [CrossRef] [PubMed]
[3] Huang, D.Q., Wilson, L.A., Behling, C., et al. (2023) Fibrosis Progression Rate in Biopsy-Proven Nonalcoholic Fatty Liver Disease among People with Diabetes versus People without Diabetes: A Multicenter Study. Gastroenterology, 165, 463-472.e5.
[4] 年福临, 鲁晓岚. 糖尿病与非酒精性脂肪性肝病[J]. 实用肝脏病杂志, 2022, 25(3): 314-317.
[5] Adams, L.A., Lymp, J.F., St. Sauver, J., Sanderson, S.O., Lindor, K.D., Feldstein, A., et al. (2005) The Natural History of Nonalcoholic Fatty Liver Disease: A Population-Based Cohort Study. Gastroenterology, 129, 113-121. [Google Scholar] [CrossRef] [PubMed]
[6] Williamson, R.M., Price, J.F., Glancy, S., Perry, E., Nee, L.D., Hayes, P.C., et al. (2011) Prevalence of and Risk Factors for Hepatic Steatosis and Nonalcoholic Fatty Liver Disease in People with Type 2 Diabetes: The Edinburgh Type 2 Diabetes Study. Diabetes Care, 34, 1139-1144. [Google Scholar] [CrossRef] [PubMed]
[7] Lv, W., et al. (2013) Nonalcoholic Fatty Liver Disease and Microvascular Complications in Type 2 Diabetes. World Journal of Gastroenterology, 19, 3134-3142. [Google Scholar] [CrossRef] [PubMed]
[8] Mantovani, A., Rigamonti, A., Bonapace, S., Bolzan, B., Pernigo, M., Morani, G., et al. (2016) Nonalcoholic Fatty Liver Disease Is Associated with Ventricular Arrhythmias in Patients with Type 2 Diabetes Referred for Clinically Indicated 24-Hour Holter Monitoring. Diabetes Care, 39, 1416-1423. [Google Scholar] [CrossRef] [PubMed]
[9] Guo, K., Zhang, L., Lu, J., Yu, H., Wu, M., Bao, Y., et al. (2017) Non-Alcoholic Fatty Liver Disease Is Associated with Late but Not Early Atherosclerotic Lesions in Chinese Inpatients with Type 2 Diabetes. Journal of Diabetes and its Complications, 31, 80-85. [Google Scholar] [CrossRef] [PubMed]
[10] Yi, M., Chen, R., Yang, R. and Chen, H. (2016) Increased Prevalence and Risk of Non‐Alcoholic Fatty Liver Disease in Overweight and Obese Patients with Type 2 Diabetes in South China. Diabetic Medicine, 34, 505-513. [Google Scholar] [CrossRef] [PubMed]
[11] Lazo, M. and Clark, J. (2008) The Epidemiology of Nonalcoholic Fatty Liver Disease: A Global Perspective. Seminars in Liver Disease, 28, 339-350. [Google Scholar] [CrossRef] [PubMed]
[12] Portillo-Sanchez, P., Bril, F., Maximos, M., Lomonaco, R., Biernacki, D., Orsak, B., et al. (2015) High Prevalence of Nonalcoholic Fatty Liver Disease in Patients with Type 2 Diabetes Mellitus and Normal Plasma Aminotransferase Levels. The Journal of Clinical Endocrinology & Metabolism, 100, 2231-2238. [Google Scholar] [CrossRef] [PubMed]
[13] Bazick, J., Donithan, M., Neuschwander-Tetri, B.A., Kleiner, D., Brunt, E.M., Wilson, L., et al. (2015) Clinical Model for NASH and Advanced Fibrosis in Adult Patients with Diabetes and NAFLD: Guidelines for Referral in NAFLD. Diabetes Care, 38, 1347-1355. [Google Scholar] [CrossRef] [PubMed]
[14] Tanase, D.M., Gosav, E.M., Costea, C.F., Ciocoiu, M., Lacatusu, C.M., Maranduca, M.A., et al. (2020) The Intricate Relationship between Type 2 Diabetes Mellitus (T2DM), Insulin Resistance (IR), and Nonalcoholic Fatty Liver Disease (NAFLD). Journal of Diabetes Research, 2020, Article ID: 3920196. [Google Scholar] [CrossRef] [PubMed]
[15] 张永超, 李威. 糖尿病和非酒精性脂肪性肝病相关肝细胞癌的相互关系[J]. 临床肝胆病杂志, 2020, 36(10): 2329-2332.
[16] Tamura, S. and Shimomura, I. (2005) Contribution of Adipose Tissue and De Novo Lipogenesis to Nonalcoholic Fatty Liver Disease. Journal of Clinical Investigation, 115, 1139-1142. [Google Scholar] [CrossRef] [PubMed]
[17] Mota, M., Banini, B.A., Cazanave, S.C. and Sanyal, A.J. (2016) Molecular Mechanisms of Lipotoxicity and Glucotoxicity in Nonalcoholic Fatty Liver Disease. Metabolism, 65, 1049-1061. [Google Scholar] [CrossRef] [PubMed]
[18] Solinas, G. and Becattini, B. (2017) JNK at the Crossroad of Obesity, Insulin Resistance, and Cell Stress Response. Molecular Metabolism, 6, 174-184. [Google Scholar] [CrossRef] [PubMed]
[19] Verboven, K., Wouters, K., Gaens, K., Hansen, D., Bijnen, M., Wetzels, S., et al. (2018) Abdominal Subcutaneous and Visceral Adipocyte Size, Lipolysis and Inflammation Relate to Insulin Resistance in Male Obese Humans. Scientific Reports, 8, Article No. 4677. [Google Scholar] [CrossRef] [PubMed]
[20] Li, G., Feng, D., Qu, X., Fu, J., Wang, Y., Li, L., et al. (2018) Role of Adipokines FGF21, Leptin and Adiponectin in Self-Concept of Youths with Obesity. European Neuropsychopharmacology, 28, 892-902. [Google Scholar] [CrossRef] [PubMed]
[21] Boutari, C. and Mantzoros, C.S. (2020) Adiponectin and Leptin in the Diagnosis and Therapy of NAFLD. Metabolism, 103, Article ID: 154028. [Google Scholar] [CrossRef] [PubMed]
[22] Fang, Y., Chen, H., Wang, C. and Liang, L. (2018) Pathogenesis of Non-Alcoholic Fatty Liver Disease in Children and Adolescence: From “Two Hit Theory” to “Multiple Hit Model”. World Journal of Gastroenterology, 24, 2974-2983. [Google Scholar] [CrossRef] [PubMed]
[23] Taylor, R.S., Taylor, R.J., Bayliss, S., Hagström, H., Nasr, P., Schattenberg, J.M., et al. (2020) Association between Fibrosis Stage and Outcomes of Patients with Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis. Gastroenterology, 158, 1611-1625.e12. [Google Scholar] [CrossRef] [PubMed]
[24] Rinella, M.E., Neuschwander-Tetri, B.A., Siddiqui, M.S., Abdelmalek, M.F., Caldwell, S., Barb, D., et al. (2023) AASLD Practice Guidance on the Clinical Assessment and Management of Nonalcoholic Fatty Liver Disease. Hepatology, 77, 1797-1835. [Google Scholar] [CrossRef] [PubMed]
[25] Eslam, M., Sarin, S.K., Wong, V.W., Fan, J., Kawaguchi, T., Ahn, S.H., et al. (2020) The Asian Pacific Association for the Study of the Liver Clinical Practice Guidelines for the Diagnosis and Management of Metabolic Associated Fatty Liver Disease. Hepatology International, 14, 889-919. [Google Scholar] [CrossRef] [PubMed]
[26] 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. 非酒精性脂肪性肝病防治指南(2018年更新版) [J]. 临床肝胆病杂志, 2018, 34(5): 947-957.
[27] Wong, V.W., Chan, W., Chitturi, S., Chawla, Y., Dan, Y.Y., Duseja, A., et al. (2017) Asia-Pacific Working Party on Non‐Alcoholic Fatty Liver Disease Guidelines 2017—Part 1: Definition, Risk Factors and Assessment. Journal of Gastroenterology and Hepatology, 33, 70-85. [Google Scholar] [CrossRef] [PubMed]
[28] European Association for Study of Liver, Asociacion Latinoamericana para el Estudio del Higado (2015) EASL-ALEH Clinical Practice Guidelines: Non-Invasive Tests for Evaluation of Liver Disease Severity and Prognosis. Journal of Hepatology, 63, 237-264.
[29] Patel, K. and Sebastiani, G. (2020) Limitations of Non-Invasive Tests for Assessment of Liver Fibrosis. JHEP Reports, 2, Article ID: 100067. [Google Scholar] [CrossRef] [PubMed]
[30] Angulo, P., Hui, J.M., Marchesini, G., Bugianesi, E., George, J., Farrell, G.C., et al. (2007) The NAFLD Fibrosis Score: A Noninvasive System That Identifies Liver Fibrosis in Patients with NAFLD. Hepatology, 45, 846-854. [Google Scholar] [CrossRef] [PubMed]
[31] Musso, G., Gambino, R., Cassader, M. and Pagano, G. (2010) Meta-Analysis: Natural History of Non-Alcoholic Fatty Liver Disease (NAFLD) and Diagnostic Accuracy of Non-Invasive Tests for Liver Disease Severity. Annals of Medicine, 43, 617-649. [Google Scholar] [CrossRef] [PubMed]
[32] Patel, P., Hossain, F., Horsfall, L.U., Banh, X., Hayward, K.L., Williams, S., et al. (2018) A Pragmatic Approach Identifies a High Rate of Nonalcoholic Fatty Liver Disease with Advanced Fibrosis in Diabetes Clinics and At‐Risk Populations in Primary Care. Hepatology Communications, 2, 897-909. [Google Scholar] [CrossRef] [PubMed]
[33] Kaswala, D.H., Lai, M. and Afdhal, N.H. (2016) Fibrosis Assessment in Nonalcoholic Fatty Liver Disease (NAFLD) in 2016. Digestive Diseases and Sciences, 61, 1356-1364. [Google Scholar] [CrossRef] [PubMed]
[34] Armstrong, M.J. and Marchesini, G. (2019) Referral Pathways for NAFLD Fibrosis in Primary Care—No Longer a “Needle in a Haystack”. Journal of Hepatology, 71, 246-248. [Google Scholar] [CrossRef] [PubMed]
[35] Irvine, K.M., Wockner, L.F., Shanker, M., Fagan, K.J., Horsfall, L.U., Fletcher, L.M., et al. (2015) The Enhanced Liver Fibrosis Score Is Associated with Clinical Outcomes and Disease Progression in Patients with Chronic Liver Disease. Liver International, 36, 370-377. [Google Scholar] [CrossRef] [PubMed]
[36] Yeh, W., Li, P., Jeng, Y., Hsu, H., Kuo, P., Li, M., et al. (2002) Elastic Modulus Measurements of Human Liver and Correlation with Pathology. Ultrasound in Medicine & Biology, 28, 467-474. [Google Scholar] [CrossRef] [PubMed]
[37] 中国肝炎防治基金会, 中华医学会感染病学分会, 中华医学会肝病学分会和中国研究型医院学会肝病专业委员会, 等. 瞬时弹性成像技术诊断肝纤维化专家共识(2018年更新版) [J]. 中华肝脏病杂志, 2019, 27(3): 182-191.
[38] Chitturi, S., Wong, V.W., Chan, W., Wong, G.L., Wong, S.K., Sollano, J., et al. (2017) The Asia-Pacific Working Party on Non‐Alcoholic Fatty Liver Disease Guidelines 2017—Part 2: Management and Special Groups. Journal of Gastroenterology and Hepatology, 33, 86-98. [Google Scholar] [CrossRef] [PubMed]
[39] Plauth, M., Bernal, W., Dasarathy, S., Merli, M., Plank, L.D., Schütz, T., et al. (2019) ESPEN Guideline on Clinical Nutrition in Liver Disease. Clinical Nutrition, 38, 485-521. [Google Scholar] [CrossRef] [PubMed]
[40] Promrat, K., Kleiner, D.E., Niemeier, H.M., Jackvony, E., Kearns, M., Wands, J.R., et al. (2009) Randomized Controlled Trial Testing the Effects of Weight Loss on Nonalcoholic Steatohepatitis. Hepatology, 51, 121-129. [Google Scholar] [CrossRef] [PubMed]
[41] American Diabetes Association (2017) 8. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2018. Diabetes Care, 41, S73-S85. [Google Scholar] [CrossRef] [PubMed]

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