代谢功能障碍相关的脂肪性肝病在 2 型糖尿病患者中的作用：心力衰竭的风险。

Metabolic dysfunction-associated steatotic liver disease in patients with type 2 diabetes: risk of heart failure.

机构信息

Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.

Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

出版信息

Cardiovasc Diabetol. 2024 Nov 1;23(1):391. doi: 10.1186/s12933-024-02489-4.

DOI:10.1186/s12933-024-02489-4

PMID:39487482

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11531181/

Abstract

BACKGROUND AND AIMS

The association between metabolic dysfunction-associated steatotic liver disease (MASLD) and cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM) is unclear. This study aimed to investigate the impact of spectrum of SLD on the risk of heart failure and cardiovascular (CV) mortality in patients with T2DM.

METHODS

In a nationwide cohort study, 2,745,689 adults with T2DM were followed from 2009 to 2012 until 2018. Participants were categorized into no steatotic liver disease (no SLD) and SLD groups. The SLD group was stratified based on metabolic risk factors, alcohol consumption and viral hepatitis. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for heart failure (HF) and CV mortality risk.

RESULTS

The prevalence of MASLD, metabolic alcohol-associated liver disease (MetALD), alcohol-associated liver disease with metabolic dysfunction (ALD with MD) and MASLD with viral hepatitis (VH) was 49.6%, 7.2%, 2.3%, and 2.0%. Individuals with MASLD (adjusted HR [aHR], 1.11), MetALD (aHR, 1.14), ALD with MD (aHR, 1.32) and MASLD with VH (aHR, 1.12) had a higher risk of developing HF compared with the no SLD group. The risk of CV mortality was also increased in those with SLD groups compared to those with no SLD. The risk of new-onset HF and CV mortality showed a J-shaped association with alcohol consumption regardless of SLD status.

CONCLUSION

SLD is independent risk factor of new-onset HF and CV mortality in persons with T2DM, and alcohol consumption has a J-shaped association with risk of HF and CV mortality, regardless of SLD status.

摘要

背景与目的

代谢相关脂肪性肝病（MASLD）与 2 型糖尿病（T2DM）患者心血管结局的关系尚不清楚。本研究旨在探讨不同谱的 SLD 对 T2DM 患者心力衰竭（HF）和心血管（CV）死亡风险的影响。

方法

在一项全国性队列研究中，对 2745689 名 T2DM 成人患者进行了随访，随访时间从 2009 年至 2012 年，直至 2018 年。将参与者分为无脂肪性肝病（无 SLD）和 SLD 组。根据代谢危险因素、饮酒和病毒性肝炎对 SLD 组进行分层。使用 Cox 比例风险模型估计 HF（HR）和 CV 死亡率风险的风险比（HR）和 95%置信区间（CI）。

结果

MASLD、代谢性酒精性肝病（MetALD）、代谢功能障碍相关酒精性肝病（ALD 伴 MD）和 MASLD 伴病毒性肝炎（VH）的患病率分别为 49.6%、7.2%、2.3%和 2.0%。与无 SLD 组相比，MASLD（调整后的 HR [aHR]，1.11）、MetALD（aHR，1.14）、ALD 伴 MD（aHR，1.32）和 MASLD 伴 VH（aHR，1.12）患者发生 HF 的风险更高。与无 SLD 组相比，SLD 组的 CV 死亡率风险也增加。无论 SLD 状态如何，新发生 HF 和 CV 死亡率的风险与饮酒呈 J 形关联。