Nonalcoholic fatty liver disease increases risk of death among patients with diabetes: a community-based cohort study.
Nonalcoholic fatty liver disease increases risk of death among patients with diabetes: a community-based cohort study.
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DOI：
10.1038/ajg.2010.18
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发表时间：
2010-07
影响因子：
9.8
通讯作者：
Angulo, Paul
中科院分区：
文献类型：
--
作者：
Adams, Leon A.;Harmsen, Scott;St Sauver, Jennifer L.;Charatcharoenwitthaya, Phunchai;Enders, Felicity B.;Therneau, Terry;Angulo, Paul
非酒精性脂肪性肝病（NAFLD）在糖尿病患者中的意义尚不明确。我们试图确定NAFLD的诊断是否会影响一个基于社区的2型糖尿病患者队列的死亡率。
通过罗切斯特流行病学项目和梅奥实验室信息系统，确定了1980 - 2000年间在明尼苏达州奥姆斯特德县被诊断患有糖尿病的337名居民，并对其进行了10.9 ± 5.2年（范围0.1 - 25年）的随访。使用考克斯比例风险模型进行生存分析，将NAFLD作为一个时间依赖性协变量。
在337名居民中，116人在糖尿病诊断后0.9 ± 4.6年被诊断为NAFLD。NAFLD患者更年轻，更有可能是女性且肥胖。总体上，337名患者中有99人（29%）死亡。在调整混杂因素的多变量分析中，总体死亡率与NAFLD的诊断显著相关（风险比[HR] 2.2；95%置信区间[CI] 1.1，4.2；p = 0.03）、缺血性心脏病的存在（HR 2.3；95% CI 1.2，4.4）以及糖尿病病程（每1年的HR，1.1；95% CI 1.03，1.2）。NAFLD队列中最常见的死亡原因是恶性肿瘤（占死亡人数的33%）、肝脏相关并发症（占死亡人数的19%）和缺血性心脏病（占死亡人数的19%）。在调整后的多变量模型中，NAFLD与死于恶性肿瘤的风险增加有临界相关性（HR 2.3；95% CI 0.9，5.9；p = 0.09），与死于心血管疾病无关（HR 0.9；95% CI 0.3，2.4；p = 0.81）。
NAFLD的诊断与糖尿病患者总体死亡风险增加有关。
The significance of non-alcoholic fatty liver disease (NAFLD) among patients with diabetes is unknown. We sought to determine whether a diagnosis of NAFLD influenced mortality among a community-based cohort of patients with type 2 diabetes mellitus. 337 residents of Olmsted County, Minnesota with diabetes mellitus diagnosed between 1980–2000 were identified using the Rochester Epidemiology Project and the Mayo Laboratory Information System and followed for 10.9 ± 5.2 years (range 0.1–25). Survival was analysed using Cox proportional hazards modelling with NAFLD treated as a time-dependent covariate. Among the 337 residents, 116 were diagnosed with NAFLD 0.9 ±4.6 years after diabetes diagnosis. Patients with NAFLD were younger, and more likely to be female, and obese. Overall 99/337 (29%) patients died. In multivariate analysis to adjust for confounders, overall mortality was significantly associated with a diagnosis of NAFLD (hazard ratio [HR] 2.2; 95% confidence Interval [CI] 1.1, 4.2; p = 0.03), presence of ischemic heart disease (HR 2.3; 95% CI 1.2, 4.4), and duration of diabetes (HR per 1 year, 1.1; 95% CI 1.03, 1.2). The most common causes of death in the NAFLD cohort were malignancy (33% of deaths), liver-related complications (19% of deaths), and ischemic heart disease (19% of deaths). In adjusted multivariate models, NAFLD was borderline associated with an increased risk of dying from malignancy (HR 2.3; 95% CI 0.9, 5.9; p = 0.09), and not from cardiovascular disease (HR 0.9; 95% CI 0.3, 2.4; p = 0.81) The diagnosis of NAFLD is associated with an increased risk of overall death among patients with diabetes mellitus.
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