MAFLD 与糖尿病、慢性肾病和心血管疾病的关联：

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摘要

背景与目的

2020年，代谢功能障碍相关脂肪肝病（MAFLD）的术语被提议取代非酒精性脂肪肝病（NAFLD）。这项工作旨在调查 MAFLD 的患病率和发病率，并评估其对肝外疾病发生的影响。

方法

这项研究总共纳入了 6873 名受试者，并进行了 4.6 年的随访。使用逻辑回归和 Cox 比例风险模型检查 MAFLD 和 NAFLD 与糖尿病、慢性肾脏病 (CKD) 和心血管疾病 (CVD) 的关联。

结果

NAFLD 和 MAFLD 的患病率分别为 40.3% (95% CI, 39.2%-41.5%) 和 46.7% (95% CI, 45.6%-47.9%)。此外，321 名 (4.7%) 和 156 名 (2.3%) 参与者因过度饮酒和乙型肝炎病毒 (HBV) 感染而患有 MAFLD。随访期间，NAFLD和MAFLD的发生率分别为22.7%（95% CI，21.3%-24.0%）和27.0%（95% CI，25.5%-28.4%）。MAFLD 与较高的糖尿病发生风险相关（风险比 [RR] 2.08；95% CI，1.72-2.52）、CKD（RR 1.64；95% CI，1.39-1.94）和 CVD（风险比 1.44；95% CI，1.72-2.52）和 CVD（风险比 1.44；95% CI） ，1.15-1.81）。观察到 NAFLD 也有类似的关联。此外，过度饮酒（RR 2.49；95% CI，1.64-3.78）和 HBV 感染（RR 1.98；95% CI，1.11-3.52）的 MAFLD 亚组与较高的糖尿病风险相关。

结论

从 NAFLD 到 MAFLD 的变化并没有极大地影响与糖尿病、CKD 和 CVD 的关联。MAFLD进一步确定了代谢性脂肪肝合并过量饮酒和乙型肝炎病毒感染的患者，与非脂肪肝患者相比，这些患者发生糖尿病的风险更高。

原文

Context

In 2020, the terminology of metabolic dysfunction–associated fatty liver disease (MAFLD) was proposed to replace nonalcoholic fatty liver disease (NAFLD).

Objectives

This work aimed to investigate the prevalence and incidence of MAFLD and evaluate its effects on incident extrahepatic diseases.

Methods

A total of 6873 individuals, with a 4.6-year follow-up, were included in this study. Associations of MAFLD and NAFLD with diabetes, chronic kidney disease (CKD), and cardiovascular disease (CVD) were examined using logistic regression and Cox proportional hazards models.

Results

The prevalence of NAFLD and MAFLD was 40.3% (95% CI, 39.2%-41.5%) and 46.7% (95% CI, 45.6%-47.9%), respectively. Additionally, 321 (4.7%) and 156 (2.3%) participants had MAFLD with excessive alcohol consumption and hepatitis B virus (HBV) infection. During the follow-up period, the incidence of NAFLD and MAFLD was 22.7% (95% CI, 21.3%-24.0%) and 27.0% (95% CI, 25.5%-28.4%). MAFLD was associated with higher risks of incident diabetes (risk ratio [RR] 2.08; 95% CI, 1.72-2.52), CKD (RR 1.64; 95% CI, 1.39-1.94), and CVD (hazard ratio 1.44; 95% CI, 1.15-1.81). Similar associations for NAFLD were observed. Furthermore, the MAFLD subgroups with excessive alcohol consumption (RR 2.49; 95% CI, 1.64-3.78) and HBV infection (RR 1.98; 95% CI, 1.11-3.52) were associated with higher risks of incident diabetes.

Conclusion

The change from NAFLD to MAFLD did not greatly affect the associations with diabetes, CKD, and CVD. MAFLD further identified those patients of metabolically fatty liver combined with excessive alcohol consumption and HBV infection, who had increased risks of incident diabetes compared with those of non–fatty liver.

原文链接

Liang Y, Chen H, Liu Y, Hou X, Wei L, Bao Y, Yang C, Zong G, Wu J, Jia W. Association of MAFLD With Diabetes, Chronic Kidney Disease, and Cardiovascular Disease: A 4.6-Year Cohort Study in China. J Clin Endocrinol Metab. 2022 Jan 1;107(1):88-97. doi: 10.1210/clinem/dgab641. PMID: 34508601; PMCID: PMC8684479.

专家介绍

王明伟

医学博士，副主任医师，硕士研究生导师，浙江省医坛新秀，杭州市心血管病研究所副所长，杭州市马拉松研究所副所长，曾任杭州市临安区第四人民医院副院长，杭州师范大学附属医院科研部副主任，杭州市博士创新站负责人（临安区第四人民医院），杭州师范大学十佳研究生优良学风示范团队。擅长疑难心血管病，尤其是冠状动脉复杂、急性或慢性闭塞性病变的介入手术治疗。熟练开展急诊经皮冠状动脉球囊成形术、冠脉内超声术、主动脉内气囊反搏术、冠脉内血栓抽吸术，完成各类冠心病手术2000余例。主持各类课题8项，发表论文50余篇，专利5项，SCI收录30余篇。致力于脂肪肝心脏病学的研究和传播。任中国医药教育协会心血管内科专业委员会常务委员，浙江省医学会心血管病学分会青年委员，浙江省医学会科研管理分会委员，浙江省医学会临床试验和伦理分会委员。

门诊时间：

每周三下午代谢病中心（杭师大附院门诊楼五楼代谢病门诊）

周六上午精英门诊（杭师大附院门诊楼六楼名医门诊）

胡思琪｜编辑

王明伟｜校对

杭州市心血管病研究所

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