Huang Xiuxian, Li Zhengming, Zhai Zhenwei, Wang Qiu, Wei Rongyan, Mo Jiacheng, Huang Jianhao, Lu Wensheng
Department of Endocrinology and Metabolism of Guangxi Academy of Medical Sciences, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China.
Information Network Center of Guangxi Academy of Medical Sciences, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China.
Diabetes Metab Syndr Obes. 2024 Mar 6;17:1119-1130. doi: 10.2147/DMSO.S447897. eCollection 2024.
Metabolic dysfunction-related fatty liver disease (MAFLD) is closely related to metabolic disorders. However, the relationship between MAFLD and the prognosis in diabetic foot ulcers (DFUs) remains unclear. This study aimed to explore the association between MAFLD and the risk of major adverse cardiac and cerebral events (MACCEs) in patients with DFUs.
889 inpatients with DFUs (PEDIS/TEXAS mild and above) were included in this study from 2013 to 2023. All participants were placed into non-MAFLD ( = 643) and MAFLD ( = 246) groups and followed up every 6 months for 10.9 years with a median of 63 months through in-person outpatient interviews and family fixed-line telephone visits. The association between MAFLD and the risk of MACCEs was evaluated through Multivariate Cox regression analyses, Stratified analyses and Kaplan-Meier survival analyses.
Of the 889 subjects, 214 (24.07%) experienced MACCEs. Multivariate Cox regression analysis showed that MAFLD was independently associated with MACCEs ( < 0.001), of which with non-fatal myocardial infarction ( = 0.04), non-fatal stroke ( = 0.047), coronary artery revascularization ( = 0.002), heart failure (P = 0.029), and all-cause mortality ( = 0.021), respectively. The stratified analysis revealed that compared with non-MAFLD (HR=1), DFUs with MAFLD had a 2.64-fold increased risk for MACCEs (P <0.001; for interaction = 0.001) in peripheral arterial disease (PAD) subgroup. Kaplan-Meier analysis evidenced that the MAFLD group had a higher cumulative incidence of MACCEs (log-rank, all < 0.05).
MAFLD is a high-risk factor for MACCEs in patients with DFUs. The findings will remind clinicians to pay more attention to MAFLD in patients with DFUs, especially in patients with DFUs combined with PAD as early as possible in clinical practice and adopt timely effective intervention strategies to prevent the occurrence of MACCEs to improve the clinical prognosis in patients with DFUs.
代谢功能障碍相关脂肪性肝病（MAFLD）与代谢紊乱密切相关。然而，MAFLD与糖尿病足溃疡（DFU）预后之间的关系仍不明确。本研究旨在探讨MAFLD与DFU患者发生主要不良心脑血管事件（MACCE）风险之间的关联。
本研究纳入了2013年至2023年期间889例DFU住院患者（PEDIS/TEXAS分级为轻度及以上）。所有参与者被分为非MAFLD组（n = 643）和MAFLD组（n = 246），通过门诊面对面访谈和家庭固定电话随访，每6个月随访一次，共随访10.9年，中位随访时间为63个月。通过多变量Cox回归分析、分层分析和Kaplan-Meier生存分析评估MAFLD与MACCE风险之间的关联。
在889名受试者中，214名（24.07%）发生了MACCE。多变量Cox回归分析显示，MAFLD与MACCE独立相关（P < 0.001），其中分别与非致命性心肌梗死（P = 0.04）、非致命性中风（P = 0.047）、冠状动脉血运重建（P = 0.002）、心力衰竭（P = 0.029）和全因死亡率（P = 0.021）相关。分层分析显示，与非MAFLD组（HR = 1）相比，MAFLD合并DFU患者在周围动脉疾病（PAD）亚组中发生MACCE的风险增加2.64倍（P < 0.001；交互作用P = 0.001）。Kaplan-Meier分析表明，MAFLD组MACCE的累积发生率更高（对数秩检验，所有P < 0.05）。
MAFLD是DFU患者发生MACCE的高危因素。这些发现将提醒临床医生在临床实践中更多关注DFU患者中的MAFLD，尤其是合并PAD的DFU患者，尽早采取及时有效的干预策略以预防MACCE的发生，从而改善DFU患者的临床预后。
