脂肪肝指数是 1 型糖尿病患者全因死亡率和主要心血管事件的独立危险因素：一项 11 年观察性研究。
Fatty liver index is an independent risk factor for all-cause mortality and major cardiovascular events in type 1 diabetes: an 11-year observational study.
机构信息
Section of Diabetes and Metabolic Diseases, Department of Clinical and Experimental Medicine, University of Pisa, Via A. Trivella, 1, 56126, Pisa, Italy.
Department of Medical Specialties, University Hospital of Pisa, Pisa, Italy.
出版信息
Cardiovasc Diabetol. 2024 Feb 28;23(1):85. doi: 10.1186/s12933-024-02171-9.
BACKGROUND
Non-alcoholic fatty liver disease (NAFLD), identified by the Fatty Liver Index (FLI), is associated with increased mortality and cardiovascular (CV) outcomes. Whether this also applies to type 1 diabetes (T1D) has not been yet reported.
METHODS
We prospectively observed 774 subjects with type 1 diabetes (males 52%, 30.3 ± 11.1 years old, diabetes duration (DD) 18.5 ± 11.6 years, HbA1c 7.8 ± 1.2%) to assess the associations between FLI (based on BMI, waist circumference, gamma-glutamyl transferase and triglycerides) and all-cause death and first CV events.
RESULTS
Over a median 11-year follow-up, 57 subjects died (7.4%) and 49 CV events (6.7%) occurred among 736 individuals with retrievable incidence data. At baseline, FLI was < 30 in 515 subjects (66.5%), 30-59 in 169 (21.8%), and ≥ 60 in 90 (11.6%). Mortality increased steeply with FLI: 3.9, 10.1, 22.2% (p < 0.0001). In unadjusted Cox analysis, compared to FLI < 30, risk of death increased in FLI 30-59 (HR 2.85, 95% CI 1.49-5.45, p = 0.002) and FLI ≥ 60 (6.07, 3.27-11.29, p < 0.0001). Adjusting for Steno Type 1 Risk Engine (ST1-RE; based on age, sex, DD, systolic BP, LDL cholesterol, HbA1c, albuminuria, eGFR, smoking and exercise), HR was 1.52 (0.78-2.97) for FLI 30-59 and 3.04 (1.59-5.82, p = 0.001) for FLI ≥ 60. Inclusion of prior CV events slightly modified HRs. FLI impact was confirmed upon adjustment for EURODIAB Risk Engine (EURO-RE; based on age, HbA1c, waist-to-hip ratio, albuminuria and HDL cholesterol): FLI 30-59: HR 1.24, 0.62-2.48; FLI ≥ 60: 2.54, 1.30-4.95, p = 0.007), even after inclusion of prior CVD. CV events incidence increased with FLI: 3.5, 10.5, 17.2% (p < 0.0001). In unadjusted Cox, HR was 3.24 (1.65-6.34, p = 0.001) for FLI 30-59 and 5.41 (2.70-10.83, p < 0.0001) for FLI ≥ 60. After adjustment for ST1-RE or EURO-RE, FLI ≥ 60 remained statistically associated with risk of incident CV events, with trivial modification with prior CVD inclusion.
CONCLUSIONS
This observational prospective study shows that FLI is associated with higher all-cause mortality and increased risk of incident CV events in type 1 diabetes.
背景
非酒精性脂肪性肝病 (NAFLD) 通过脂肪性肝病指数 (FLI) 确定，与死亡率和心血管 (CV) 结局增加相关。这种情况是否也适用于 1 型糖尿病 (T1D) 尚未有报道。
方法
我们前瞻性观察了 774 例 1 型糖尿病患者（男性占 52%，30.3±11.1 岁，糖尿病病程 (DD) 18.5±11.6 年，糖化血红蛋白 (HbA1c) 7.8±1.2%），以评估 FLI（基于 BMI、腰围、γ-谷氨酰转移酶和甘油三酯）与全因死亡和首次 CV 事件之间的关系。
结果
在中位 11 年的随访中，736 例可获得发病数据的患者中，有 57 例死亡（7.4%）和 49 例 CV 事件（6.7%）发生。基线时，515 例患者（66.5%）的 FLI<30，169 例（21.8%）的 FLI 为 30-59，90 例（11.6%）的 FLI≥60。死亡率随 FLI 急剧增加：3.9%、10.1%、22.2%（p<0.0001）。在未调整的 Cox 分析中，与 FLI<30 相比，FLI 30-59（HR 2.85，95%CI 1.49-5.45，p=0.002）和 FLI≥60（HR 6.07，95%CI 3.27-11.29，p<0.0001）的死亡风险增加。调整 Steno 1 型风险引擎（基于年龄、性别、DD、收缩压、LDL 胆固醇、HbA1c、白蛋白尿、eGFR、吸烟和运动）后，FLI 30-59 的 HR 为 1.52（0.78-2.97），FLI≥60 的 HR 为 3.04（1.59-5.82，p=0.001）。先前的 CV 事件略微改变了 HR。在调整 EURODIAB 风险引擎（基于年龄、HbA1c、腰臀比、白蛋白尿和 HDL 胆固醇）后，FLI 的影响得到了证实：FLI 30-59：HR 1.24，0.62-2.48；FLI≥60：HR 2.54，1.30-4.95，p=0.007），即使在包括先前的 CVD 后也是如此。CV 事件发生率随 FLI 增加而增加：3.5%、10.5%、17.2%（p<0.0001）。在未调整的 Cox 中，FLI 30-59 的 HR 为 3.24（1.65-6.34，p=0.001），FLI≥60 的 HR 为 5.41（2.70-10.83，p<0.0001）。调整 ST1-RE 或 EURO-RE 后，FLI≥60 与 CV 事件的发生风险仍具有统计学相关性，先前的 CVD 纳入后仅有轻微改变。
结论
这项前瞻性观察研究表明，FLI 与 1 型糖尿病患者的全因死亡率增加和 CV 事件风险增加相关。
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