非酒精性脂肪性肝病合并2型糖尿病患者肝组织病理学变化研究

目的 研究非酒精性脂肪性肝病（NAFLD）合并2型糖尿病（T2DM）患者肝脏组织病理学变化。方法 分析240例行肝活检术的NAFLD患者临床资料,比较NAFLD合并T2DM与未合并T2DM患者肝组织病理学表现和评分的差异。结果 在240例NAFLD患者中,合并2型糖尿病者80例（33.3%）,未合并T2DM 者160例（66.7%）;在NAFLD合并T2DM患者中非酒精性脂肪性肝炎（NASH）60例、肝纤维化20例,未合并T2DM患者中分别为68例和92例;在NAFLD合并T2DM患者中检出肝纤维化评分≥2者30例（37.5%）、肝细胞气球样变评分≥2者23例（28.8%）和马洛里小体22例（27.5%）,均显著高于未合并T2DM患者的【20例（12.5%）、22例（13.8%）和30例（18.8%）,P<0.05】;T2DM为发生NASH（OR=3.27,95%CI：1.42~7.55）和肝纤维化（OR=3.35,95%CI：1.55~7.63）的独立危险因素。结论 合并T2DM的NAFLD患者肝组织病理学损伤更趋严重,应注意防治。

Pathological changes of liver tissues in patients with nonalcoholic fatty liver disease and type 2 diabetes mellitus

Objective To investigate the pathological changes of liver tissues in patients with nonalcoholic fatty liver disease（NAFLD） and type 2 diabetes mellitus （T2DM）. Methods The clinical data of 240 patients with biopsy proven NAFLD were analyzed. Histopathology findings of livers were compared between patients with and without T2DM. Results Out of the 240 patients,there were 80（33.3%） patients with NAFLD and T2DM,and 160 （66.7%） patients with NAFLD without T2DM;Nonalcoholic steatohepatitis （NASH） and liver fibrosis were found in 60 and 20 patients with NAFLD and T2DM,while they were in 68 and 98 patients with NAFLD without T2DM;Patients with NAFLD and T2DM had higher rates of liver fibrosis score≥2（37.5%,n=30）,ballooning score≥2（28.8%,n=23） and Mallory body（27.5%,n=22） compared to patients with NAFLD without T2DM （12.5%,n=20;13.8%,n=22 and 18.8%,n=30,P<0.05）;T2DM was independently associated with NASH （OR = 3.27,95%CI:1.42-7.55） and advanced fibrosis（OR=3.35,95%CI:1.55-7.63） in all patients with NAFLD. Conclusion The liver pathological changes in patients with NAFLD and T2DM might be severe,which warrants more attention.