Objective: To investigate the prevalence and independent risk factors of non-alcoholic fatty liver disease (NAFLD) and advanced chronic liver disease among the type 2 diabetes mellitus (T2DM) population in the Shenyang community, so as to provide evidence for the prevention and control of T2DM combined with NAFLD. Methods: This cross-sectional study was conducted in July 2021. 644 T2DM cases from 13 communities in Heping District, Shenyang City were selected. All the surveyed subjects underwent physical examination (measurements of height, body mass index, neck circumference, waist circumference, abdominal circumference, hip circumference, and blood pressure), infection screening (excluding hepatitis B and C, AIDS, and syphilis), random fingertip blood glucose, controlled attenuation parameter (CAP), and liver stiffness measurement (LSM). The study subjects were divided into the non-advanced chronic liver disease group and the advanced chronic liver disease group according to whether the LSM value was greater than 10 kPa. Cirrhotic portal hypertension development was indicated in patients with LSM ≥ 15 kPa. The comparison of multiple mean values among the sample groups was performed by analysis of variance when the normal distribution was met. Results: In the T2DM community population, there were 401 cases (62.27%) combined with NAFLD, 63 cases (9.78%) combined with advanced chronic liver disease, and 14 cases (2.17%) combined with portal hypertension. There were 581 cases in the non-advanced chronic liver disease group and 63 cases (9.78%) in the advanced chronic liver disease group (LSM ≥10 kPa), including 49 cases (7.61%) with 10 kPa≤LSM<15 kPa, 11 cases (1.71%) with 15 kPa ≤LSM<25 kPa, and 3 cases (0.47%) with LSM ≥ 25 kPa. Age, body mass, body mass index, neck circumference, waist circumference, hip circumference, waist-to-height ratio, systolic blood pressure, and CAP were all statistically different between the non-advanced chronic liver disease group and the advanced chronic liver disease group (F=-1.983,-2.598,-4.091,-2.062,-3.909, -4.581,-4.295,-2.474, and -5.191, respectively; P<0.05). There was a statistically significant difference in terms of whether or not there was combined cerebrovascular disease (2=4.632, P=0.031); however, there were no statistically significant differences in terms of lifestyle, diabetes complications, and other complications (P>0.05). Conclusion: Patients with T2DM have a higher prevalence of NAFLD (62.27%) than those with advanced chronic liver disease (9.78%). 2.17% of T2DM cases in the community may not have had early diagnosis and early intervention, and they might have been combined with cirrhotic portal hypertension. So, the management of these patients should be strengthened.
目的： 探讨沈阳社区2型糖尿病（T2DM）人群中非酒精性脂肪性肝病（NAFLD）、进展期慢性肝病的患病率和独立危险因素，为社区T2DM合并NAFLD的预防及控制提供依据。 方法： 于2021年7月在沈阳市和平区13个社区，入选T2DM患者644例进行横断面研究，对所有调查对象进行体格检查（测量身高、体质量、颈围、腰围、腹围、臀围、血压）、传染筛查（排除乙型肝炎、丙型肝炎、艾滋病、梅毒）、随机指尖血糖以及受控衰减参数（CAP）、肝脏硬度值（LSM）检查。研究对象根据LSM值是否大于10 kPa分为无进展期慢性肝病组和进展期慢性肝病组，其中LSM≥15 kPa提示患者发展为肝硬化门静脉高压。样本中组间多个均数的比较，符合正态分布时采用方差分析。 结果： 在社区T2DM人群中，合并NAFLD患者401例（62.27%），合并进展期慢性肝病患者63例（9.78%），合并门静脉高压者14例（2.17%）。无进展期慢性肝病组581例；进展期慢性肝病（LSM≥10 kPa）组［63例（9.78%）］，其中：10 kPa≤LSM<15 kPa 49例（7.61%），15 kPa≤LSM<25 kPa 11例（1.71%），LSM≥25 kPa者3例（0.47%）。无进展期慢性肝病组和进展期慢性肝病组在年龄、体质量、体质量指数、颈围、腰围、臀围、腰高比、收缩压、CAP比较，差异均有统计学意义（F值分别为-1.983、-2.598、-4.091、-2.062、-3.909、-4.581、-4.295、-2.474、-5.191；P值均<0.05）；两组在是否合并脑血管疾病上差异有统计学意义（χ2=4.632，P=0.031）；而在生活习惯、糖尿病合并症及其他并发症方面比较，P值均＞0.05，差异均无统计学意义。 结论： 在T2DM中NAFLD的患病率较高，为62.27%，进展期慢性肝病的患病率为9.78%，其中2.17%社区T2DM患者可能未早期诊断早期干预，已合并肝硬化门静脉高压，应加强该部分患者的管理。.