Department of Infectious Diseases, Taizhou Hospital, Zhejiang Province, Taizhou, China.
Department of Emergency, Taizhou Hospital, Zhejiang Province, Taizhou, China.
Front Endocrinol (Lausanne). 2021 Dec 21;12:773342. doi: 10.3389/fendo.2021.773342. eCollection 2021.
The influence of diabetes on mortality among patients with non-alcoholic fatty liver disease (NAFLD) in the general population has not been extensively studied. This study aimed to determine the relationship between diabetes and all-cause and cardiovascular mortality in patients with hepatic ultrasound-confirmed NAFLD using data from the Third National Health and Nutrition Examination Survey (NHANES III), 1988-1994.
Data from 4,037 adult individuals with NAFLD from the NHANES III and mortality outcomes linked to National Death Index records through December 31, 2015, were included. Cox proportional hazards models were used to calculate the hazard ratio (HR) and corresponding 95% CI for mortality from all causes and cardiovascular disease after adjusting for multiple variables.
Among 4,037 subjects with NAFLD (55.9% female), 483 had diabetes at baseline. During a median follow-up of 22.1 years, 1,517 (11.5%) died, including 332 (8.22%) from cardiovascular causes. Diabetes was associated with increased all-cause (HR 3.02 [95% CI 2.67-3.41]) and cardiovascular (HR 3.36 [95% CI 2.61-4.32]) mortality in an unadjusted multivariable Cox regression model. The association remained statistically significant after adjusting for a range of potential confounders (HR 2.20 [95% CI 1.90-2.55] for all-cause mortality and HR 2.47 [95% CI 1.81-3.37] for cardiovascular mortality). An additional stratified analysis did not reveal significantly altered results.
Diabetes was associated with all-cause and cardiovascular mortality in patients with NAFLD. This link could be further characterized in future studies assessing the degree of glycemic control and its relationship with mortality in patients with diabetes and NAFLD.
在普通人群中，糖尿病对非酒精性脂肪性肝病（NAFLD）患者死亡率的影响尚未得到广泛研究。本研究旨在利用 1988-1994 年第三次全国健康和营养检查调查（NHANES III）的数据，确定经肝脏超声确诊的 NAFLD 患者中糖尿病与全因和心血管死亡率之间的关系。
纳入 NHANES III 中 4037 名有 NAFLD 的成年个体的数据，以及通过国家死亡指数记录与 2015 年 12 月 31 日相关联的死亡结局。使用 Cox 比例风险模型计算死亡率的风险比（HR）和相应的 95%置信区间，用于全因和心血管疾病死亡的调整后的多变量。
在 4037 名有 NAFLD（55.9%为女性）的患者中，基线时有 483 人患有糖尿病。在中位随访 22.1 年期间，有 1517 人（11.5%）死亡，其中 332 人（8.22%）死于心血管原因。在未经调整的多变量 Cox 回归模型中，糖尿病与全因（HR 3.02 [95% CI 2.67-3.41]）和心血管（HR 3.36 [95% CI 2.61-4.32]）死亡率的增加相关。在调整了一系列潜在混杂因素后，这种关联仍然具有统计学意义（全因死亡率的 HR 2.20 [95% CI 1.90-2.55]，心血管死亡率的 HR 2.47 [95% CI 1.81-3.37]）。进一步的分层分析并未显示出明显改变的结果。
糖尿病与 NAFLD 患者的全因和心血管死亡率相关。在评估糖尿病和 NAFLD 患者的血糖控制程度及其与死亡率的关系的未来研究中，可以进一步描述这种联系。
