目的:我们研究了代谢功能障碍相关的脂肪变性肝病(MASLD)和2型糖尿病(T2D)的联合诊断对患者预后的影响。
方法:使用TriNetX,全球联合研究网络(n=1.14亿),我们进行了两项回顾性队列研究,使用时间到事件分析。分析1将MASLD与T2D与单独的MASLD进行比较;分析2将T2D与MASLD与单独的T2D进行比较。使用贪婪的最近邻(calliper.1)进行倾向评分匹配,以平衡队列(1:1)的显着协变量。主要结果是心血管疾病,肝脏,糖尿病相关,和癌症事件超过5年。
结果:分析1(n=95275):T2D的共同诊断显着增加了缺血性心脏病(IHD)的风险(HR1.39;CI:1.34,1.44),缺血性卒中(HR1.45;CI:1.35,1.56),心力衰竭(HR1.42;CI:1.36,1.49),心房颤动(HR1.09;CI:1.03,1.16),肝细胞癌(HR1.96;CI:1.69,2.27),胰腺癌(HR1.25;CI:1.06,1.48)和肝脏相关并发症超过5年从MASLD诊断。分析2(n=15208):MASLD的共同诊断显着增加了全因死亡率的风险(HR1.11;CI:1.02,1.22),IHD(HR1.181;CI:1.08,1.29),肝细胞(HR50.31;CI:6.94,364.72),胰腺(HR1.78;CI:1.12,2.84),乳腺癌(HR1.43;CI:1.09,1.88)和肾癌(HR2.01;CI:1.24,3.26),和糖尿病神经病变(HR1.17;CI:1.09,1.27)从二甲双胍开始超过5年。
结论:T2D显著增强心血管疾病的风险,MASLD患者的恶性肿瘤和肝脏相关结局。MASLD对T2D患者的影响,虽然不那么戏剧化,仍然会增加死亡风险,IHD,恶性肿瘤和周围神经病变。
OBJECTIVE: We examined the impact of a co-diagnosis of metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes (T2D) on patient outcomes.
METHODS: Using TriNetX, a global federated research network (n = 114 million), we undertook two retrospective cohort studies, using time-to-event analysis. Analysis 1 compared MASLD with T2D to MASLD alone; analysis 2 compared T2D with MASLD to T2D alone. Propensity score matching using greedy nearest neighbour (calliper .1) balanced the cohorts (1:1) for significant covariates. Primary outcomes were cardiovascular, liver, diabetes-related, and cancer events over 5 years.
RESULTS: Analysis 1 (n = 95 275): a co-diagnosis of T2D significantly increased the risk of ischaemic heart disease (IHD) (HR 1.39; CI: 1.34, 1.44), ischaemic stroke (HR 1.45; CI: 1.35, 1.56), heart failure (HR 1.42; CI: 1.36, 1.49), atrial fibrillation (HR 1.09; CI: 1.03, 1.16), hepatocellular carcinoma (HR 1.96; CI: 1.69, 2.27), pancreatic cancer (HR 1.25; CI: 1.06, 1.48) and liver-related complications over 5 years from MASLD diagnosis. Analysis 2 (n = 15 208): a co-diagnosis of MASLD significantly increased risk of all-cause mortality (HR 1.11; CI: 1.02, 1.22), IHD (HR 1.181; CI: 1.08, 1.29), hepatocellular (HR 50.31; CI: 6.94, 364.72), pancreatic (HR 1.78; CI: 1.12, 2.84), breast (HR 1.43; CI: 1.09, 1.88) and renal cancer (HR 2.01; CI: 1.24, 3.26), and diabetic neuropathy (HR 1.17; CI: 1.09, 1.27) over 5 years from metformin initiation.
CONCLUSIONS: T2D significantly potentiates the risk of cardiovascular, malignancy and liver-related outcomes in people with MASLD. The effect of MASLD on people with T2D, although less dramatic, still potentiated risk of death, IHD, malignancy and peripheral neuropathy.