Non-alcoholic fatty liver disease, metabolic goal achievement with incident cardiovascular disease and eGFR-based chronic kidney disease in patients with prediabetes and diabetes
Non-alcoholic fatty liver disease, metabolic goal achievement with incident cardiovascular disease and eGFR-based chronic kidney disease in patients with prediabetes and diabetes
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糖尿病前期和糖尿病患者的非酒精性脂肪肝、心血管疾病和基于 eGFR 的慢性肾病的代谢目标实现情况
DOI：
10.1016/j.metabol.2021.154874
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发表时间：
2021-09-14
影响因子：
9.8
通讯作者：
Wang, Weiqing
中科院分区：
文献类型：
--
作者：
Li, Mian;Zhao, Zhiyun;Wang, Weiqing
目的/假设：我们的目的是评估NAFLD对心血管疾病(CVD)和估计的基于肾小球滤过率(EGFR)的慢性肾脏疾病(CKD)风险的影响，并进一步测试前瞻性队列研究中101,296名糖尿病前期或糖尿病患者的NAFLD状态与个体代谢因素以及总的“ABC”代谢目标实现程度对CVD和CKD风险的联合影响和交互作用。方法：本研究基于中国心脏代谢性疾病与癌症队列研究(4C)，这是一项基于人群的大规模前瞻性队列研究。在排除酗酒和其他肝病原因后，我们使用脂肪肝指数(FLI)和_60作为NAFLD的替代指标，并通过天冬氨酸转氨酶/丙氨酸转氨酶比率(AAR)对纤维化的可能性进行分层，界值分别为0.8和1.4。代谢目标定义为糖化血红蛋白6.5%(A组)、SBP/DBP 130/80毫米汞柱(B组)和低密度脂蛋白100 mg/dL(C组)的受试者。在3.8年的随访中，我们根据医疗记录验证了2340例CVD事件，并根据中央测试的EGFR确定了1943名参与者患上了CKD。结果：与非NAFLD患者相比，NAFLD患者发生心血管事件的多变量调整风险比(HR)为1.15(95%可信区间，1.05~1.27)，发生CKD事件的多变量调整风险比(HR)为1.33(95%CI，1.20~1.48)。在NAFLD患者中，相对于AAR(1.4)低的个体，更容易发生CVD事件[1.62(1.21-2.18)]和CKD[1.63(1.17-2.28)]。患有NAFLD和代谢危险因素控制不佳的参与者发生心血管事件或CKD的风险比单独患有NAFLD的风险更高，血糖控制不良和NAFLD在血管并发症风险上存在显著交互作用。结论：在糖尿病前期或糖尿病患者中，NAFLD与CVD和CKD的发生有关。代谢目标的全面实现大大改变了这种联系。(C)2021 Elsevier Inc.保留所有权利。
Aims/hypothesis: We aimed to evaluate the effect of NAFLD on the risk of incident cardiovascular disease (CVD) and estimated glomerular filtration rate (eGFR)-based chronic kidney disease (CKD), and further test the joint effects and interactions between NAFLD status and individual metabolic element, as well as the total 'ABCs' met-abolic goal achievement, on the CVD and CKD risk among 101,296 patients with prediabetes or diabetes from a prospective cohort study. Methods: We conducted the study based on the China Cardiometabolic Disease and Cancer Cohort (4C) study, a large-scale, population-based prospective cohort. After excluding alcohol abuse and other cause of hepatic diseases, we used fatty liver index (FLI) >_ 60 as a proxy of NAFLD and stratified the probability of fibrosis by aspartate transaminase/alanine transaminase ratio (AAR) with cut-offs of 0.8 and 1.4. 'ABCs' metabolic goal was defined as subjects who had HbA1c < 6.5% (A), SBP/DBP < 130/80 mmHg (B), and LDL-C < 100 mg/dL (C). During 3.8 years follow-up, we validated 2340 CVD events based on medical records and identified 1943 participants developed CKD based on centrally tested eGFR. Results: The multivariable adjusted hazard ratios (HRs) were 1.15 (95% confidence interval (CI), 1.05-1.27) for CVD events and 1.33 (95% CI, 1.20-1.48) for CKD among NAFLD patients, compared with participants without NAFLD. Of NAFLD patients, relative to individuals with low AAR (_1.4) were more likely to experience CVD events [1.62 (1.21-2.18)] and CKD [1.63 (1.17-2.28)]. Participants with NAFLD and co morbid poorly controlled metabolic risk factors had higher risk of CVD events or CKD than having either alone, with a significant interaction between poor glycemic control and NAFLD on the risk of vascular complications. Conclusions: NAFLD was associated with incident CVD and CKD among patients with prediabetes or diabetes. Such associations were substantially modified by the comprehensive achievement of metabolic goal. (c) 2021 Elsevier Inc. All rights reserved.