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Thématique :
- Foie
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Bertrand HANSLIK
Coup de coeur :
 
 
Gut
  2016/08  
 
  2016 Aug;65(8):1359-68  
  doi: 10.1136/gutjnl-2015-309265  
 
  Screening diabetic patients for non-alcoholic fatty liver disease with controlled attenuation parameter and liver stiffness measurements: a prospective cohort study.  
 
  Kwok R, Choi KC, Wong GL, Zhang Y, Chan HL, Luk AO, Shu SS, Chan AW, Yeung MW, Chan JC, Kong AP, Wong VW  
  https://www.ncbi.nlm.nih.gov/pubmed/25873639  
 
 

OBJECTIVE:

Type 2 diabetes is an important risk factor for non-alcoholic fatty liver disease (NAFLD), but current guidelines provide conflicting recommendations on whether diabetic patients should be screened for NAFLD. We therefore studied the strategy of screening diabetic patients by FibroScan.

DESIGN:

Liver fat and fibrosis were assessed by controlled attenuation parameter (CAP) and liver stiffness measurements (LSM) by FibroScan at a diabetic centre for patients from primary care and hospital clinics. Probe-specific LSM cut-offs were used to detect advanced fibrosis.

RESULTS:

Of 1918 patients examined, 1799 (93.8%) had valid CAP and 1884 (98.2%) had reliable LSM (1770 with the M probe and 114 with the XL probe). The proportion of patients with increased CAP and LSM was 72.8% (95% CI 70.7% to 74.8%) and 17.7% (95% CI 16.0% to 19.5%), respectively. By multivariable analysis, female gender, higher body mass index, triglycerides, fasting plasma glucose and alanine aminotransferase (ALT) and non-insulin use were associated with increased CAP. Longer duration of diabetes, higher body mass index, increased ALT and spot urine albumin:creatinine ratio and lower high-density lipoprotein-cholesterol were associated with increased LSM. Ninety-four patients (80% had increased LSM) underwent liver biopsy: 56% had steatohepatitis and 50% had F3-4 disease.

CONCLUSIONS:

Diabetic patients have a high prevalence of NAFLD and advanced fibrosis. Those with obesity and dyslipidaemia are at particularly high risk and may be the target for liver assessment. Our data support screening for NAFLD and/or advanced fibrosis in patients with type 2 diabetes.

 
Question posée
 
Recherche de stéatopathie non alcoolique chez les patients diabétiques en utilisant le CAP et l’élastométrie.
 
Question posée
 
70% des diabétiques avaient un CAP augmenté, suggérant une stéatopathie, et 18% avaient une élasticité augmentée. L’obésité, une ALAT élevée, un HDL bas et un diabète ancien sont associés à une élasticité hépatique augmentée. 94 patients avec Fibroscan augmenté ont accepté une biopsie hépatique : 56% avaient une stéatohépatite, 21% une fibrose avancée et 29% une cirrhose. Il est suggéré de dépister une stéatopathie et une fibrose sévère chez les patients diabétiques, surtout si une obésité et une dyslipidémie sont associées.
 
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