研究还发现，在糖尿病患者中，无论是否有高脂血症，FibroTest对估测总生存和无肝病死亡生存具显著的10年预后价值。SteatoTest也是高脂血症患者CV相关死亡的预测因子。
论文摘要：
10-years prognostic value of fibrotest and steatotest for liver-related and cardiovascular death in patients with type-2 diabetes and/or hyperlipidemia
Background: Cardiovascular and liver-related deaths have been described in nonalcoholic fatty liver disease (NAFLD) that is usually associated with risk factors, as type-2 diabetes and dyslipidemia.
Aims: To evaluate the 10-year prognostic value of non-invasive markers (FibroTest-SteatoTest) for the overall survival (OS) and survivals without liver-(LRD) and cardiovascular-related death
(CVD).
Methods: A cohort of patients with diabetes and/or dyslipidemia without known liver disease was prospectively followed[1999–2012]. Mortality data, according to the International Classification of Diseases, was collected in the French National Registry. Liver diseases were presumed by validated biomarkers: Advanced liver fibrosis (AF-METAVIR≥2, FibroTest≥0.48) and advanced steatosis (>32%-AS, SteatoTest>0.69). Three sub-populations were analyzed according to the risk factors: diabetics (D), hyperlipidemia (H) and diabetics with hyperlipidemia (DH).
Results: 2322 patients[52%males, age=52yrs, BMI 26 (15–64)Kg/m2, 61%H; 11%D and 28%DH] were included. The prevalence of presumed AF were H 2.5%, D 6.5% and DH 9% (P < 0.0001). AS was presumed in H 11%, D 23% and DH 39% (P < 0.0001). During a median follow-up of 12yrs, 183 (7.8%) patients died[35 CVD; 6 LRD (4 hepatocellular-carcinoma and 2 cholangio-carcinoma)]. Both OS and survival without-CVD were significantly higher in H than in D or DH (%Kaplan–Meier, 95% CI): OS 96 (95–97) vs 93 (91–96, Logrank P < 0.001 vs H) vs 88 (85–92, P < 0.0001 vs H), respectively. Survival without CVD: 99 (98–99) vs 98 (96–99, P = 0.02 vs H) vs 97 (96–99, P < 0.001 vs H), with no LRD in H-group. OS and survival without-LDR in AF vs non-AF presumed by FT were: D-group 81 (62–99) vs 94 (91–97, P = 0.04) and 94 (82–99) vs 100 (99–100, P < 0.01); DH-group 72 (55–88) vs 89 (86–93, P = 0.04) and 90 (81–99) vs 100 (99–100, P < 0.0001), respectively. H-group
with AS presumed by Steatotest had lower survival without-CVD, compared to non-AS: 97 (94–99) vs 99 (98–99, P = 0.004). In multivariate analysis (Cox model): Fibrotest remained significant for the prediction of OS in D-group[risk ratio (RR)=136.9 (95% CI 11.6–1610; P < 0.0001)] and in DH-group [RR=7.1 (95% CI 2.1–24; P < 0.0001)].
Conclusion: Patients with type-2 diabetes especially those with associated hyperlipidemia presented higher rates of advanced fibrosis and steatosis and also higher overall and liver-related mortalities than those with isolated hyperlipidemia. In diabetics, regardless associated hyperlipemia, FibroTest had a significant 10-years prognostic value for the overall and without liver-related death survivals. SteatoTest was predictive of cardiovascular-related death in hyperlipidemia patients.
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