非酒精性脂肪性肝病与糖尿病前期和糖尿病患者的心血管结局相关：一项基于社区的前瞻性队列研究。
Non-alcoholic Fatty Liver Disease Is Associated With Cardiovascular Outcomes in Subjects With Prediabetes and Diabetes: A Prospective Community-Based Cohort Study.
作者信息
Song Qi-Rui, Liu Shuo-Lin, Bi Ya-Guang, Chen Shuo-Hua, Wu Shou-Ling, Cai Jun
机构信息
Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease of China, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.
出版信息
Front Cardiovasc Med. 2022 Apr 26;9:889597. doi: 10.3389/fcvm.2022.889597. eCollection 2022.
BACKGROUND
There have been no studies of the effect of non-alcoholic fatty liver disease (NAFLD) on cardiovascular events (CVEs) in patients with pre-diabetes (pre-DM), and diabetes mellitus (DM). We performed a community-based cohort study to evaluate the relationship between NAFLD and CVEs in patients with glucose metabolism disorder.
METHODS
We enrolled 71,852 participants from the Kailuan study who had not experienced CVEs, after excluding alcohol abuse and other liver diseases. NAFLD was assessed using abdominal ultrasonography. Besides, participants were categorized by glucose metabolism status [normal glucose regulation (NGR), pre-DM, and DM]. All subjects were followed up for the occurrence of CVEs.
RESULTS
During a median of 13.01 (0.64) years of follow-up, 6,037 CVEs occurred. NAFLD was present in 22,525 (31.3%), and compared with participants without NAFLD, those with NAFLD had a 12.3% [95% confidence interval (CI) 1.059-1.191, < 0.001] higher risk of CVEs, after adjustment for potential confounders. The hazard ratios for patients with mild, moderate, and severe NAFLD were 1.104 (95% CI 1.035-1.179, < 0.001), 1.149 (95% CI 1.055-1.251, < 0.001), and 1.235 (95% CI 1.059-1.441, < 0.001), respectively. Moreover, participants with pre-DM plus NAFLD and participants with DM plus NAFLD had 1.267-fold (95% CI 1.151-1.395, < 0.001) and 1.829-fold (95% CI 1.666-2.008, < 0.001) higher risks of CVEs, respectively, compared with those with NGR and no NAFLD. The addition of the combination of NAFLD and glucose metabolism status to the crude Cox model increased the C-statistic by 0.0066 (0.0053-0.0080, < 0.001).
CONCLUSIONS
NAFLD is associated with higher risks of CVEs. Moreover, NAFLD is an independent predictor of CVEs in patients with pre-DM and DM, suggesting that NAFLD may provide greater risk predictive value for patients with glucose metabolism disorder.
背景
目前尚无关于非酒精性脂肪性肝病（NAFLD）对糖尿病前期（pre-DM）和糖尿病（DM）患者心血管事件（CVE）影响的研究。我们进行了一项基于社区的队列研究，以评估NAFLD与糖代谢紊乱患者CVE之间的关系。
方法
我们从开滦研究中纳入了71,852名未发生CVE的参与者，排除了酗酒和其他肝脏疾病。使用腹部超声评估NAFLD。此外，参与者根据糖代谢状态[正常血糖调节（NGR）、pre-DM和DM]进行分类。所有受试者均随访CVE的发生情况。
结果
在中位13.01（0.64）年的随访期间，发生了6,037例CVE。22,525名（31.3%）存在NAFLD，与无NAFLD的参与者相比，调整潜在混杂因素后，有NAFLD的参与者发生CVE的风险高12.3%[95%置信区间（CI）1.059 - 1.191，P < 0.001]。轻度、中度和重度NAFLD患者的风险比分别为1.104（95% CI 1.035 - 1.179，P < 0.001）、1.149（95% CI 1.055 - 1.251，P < 0.001）和1.235（95% CI 1.059 - 1.441，P < 0.001）。此外，与NGR且无NAFLD的参与者相比，pre-DM加NAFLD的参与者和DM加NAFLD的参与者发生CVE的风险分别高1.267倍（95% CI 1.151 - 1.395，P < 0.001）和1.829倍（95% CI 1.666 - 2.008，P < 0.001）。将NAFLD与糖代谢状态的组合加入到粗Cox模型中，C统计量增加了0.0066（0.0053 - 0.0080，P < 0.001）。
结论
NAFLD与较高的CVE风险相关。此外，NAFLD是pre-DM和DM患者CVE的独立预测因子，表明NAFLD可能为糖代谢紊乱患者提供更大的风险预测价值。
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