代谢功能障碍相关脂肪肝合并2型糖尿病患者肝纤维化与股骨颈骨密度的非线性关系

IF 3 3区医学

Journal of Diabetes Investigation Pub Date : 2025-08-13 DOI:10.1111/jdi.70129

Jie Tao, Lin Wang, Honggang Wang, Juan Tan

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引用次数: 0

摘要

目的：虽然代谢功能障碍相关的脂肪性肝病（MAFLD）和骨质疏松症都与代谢紊乱密切相关，但它们之间的关系仍存在争议。本研究旨在探讨MAFLD合并2型糖尿病（T2DM-MAFLD）患者肝纤维化与股骨颈骨密度（BMD）的关系，并评估其代谢影响。材料和方法：我们回顾性地纳入了2018年9月至2021年5月期间住院的569例T2DM-MAFLD患者。采用纤维化-4评分（FIB-4）评估肝纤维化，采用双能x线骨密度仪测量股骨颈骨密度。广义加性模型评估非线性关系，分段线性回归识别阈值效应，分层分析探索代谢修饰因子。结果：≥50岁的绝经后女性和男性FIB-4与股骨颈骨密度呈非线性倒u型关系，FIB-4 = 2.091为转折点。低于此阈值，FIB-4与股骨颈骨密度呈显著正相关（β = 0.039, 95%CI: 0.006-0.072, P = 0.020）。超过阈值，相关性变为负但不显著（β = -0.032, 95%CI: -0.075 ~ 0.011, P = 0.141）。分层分析显示，在甘油三酯≥1.7 mmol/L的患者中，FIB-4与股骨颈BMD呈显著负相关（β = -0.025, 95%CI: -0.048, -0.003），交互作用显著（P = 0.011）。结论：在T2DM-MAFLD患者中，肝纤维化与股骨颈骨密度呈非线性关系，尤其是绝经后的女性和年龄≥50岁的男性，受血清甘油三酯调节。高甘油三酯血症可能是MAFLD患者骨质疏松发展的一个关键代谢危险因素，提示对这类患者进行骨质流失筛查的重要性，特别是那些甘油三酯升高的患者。

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Non-linear relationship between liver fibrosis and femoral neck bone mineral density in metabolic dysfunction-associated fatty liver disease patients with type 2 diabetes mellitus.

Aim: While both metabolic dysfunction-associated fatty liver disease (MAFLD) and osteoporosis are closely linked to metabolic disorders, their relationship remains controversial. This study aimed to investigate the association between liver fibrosis and femoral neck bone mineral density (BMD) in MAFLD patients with type 2 diabetes mellitus (T2DM-MAFLD) and to evaluate metabolic influences.

Materials and methods: We retrospectively enrolled 569 hospitalized T2DM-MAFLD patients between September 2018 and May 2021. Liver fibrosis was assessed using the Fibrosis-4 score (FIB-4), and femoral neck BMD was measured by dual-energy X-ray absorptiometry. Generalized additive models evaluated non-linear relationships, piecewise linear regression identified threshold effects, and stratified analyses explored metabolic modifiers.

Results: A non-linear, inverted U-shaped relationship was observed between FIB-4 and femoral neck BMD in postmenopausal women and men ≥50 years, with a turning point at FIB-4 = 2.091. Below this threshold, FIB-4 showed a significant positive correlation with femoral neck BMD (β = 0.039, 95%CI: 0.006-0.072, P = 0.020). Above the threshold, the association became negative but non-significant (β = -0.032, 95%CI: -0.075 to 0.011, P = 0.141). Stratified analysis revealed that in patients with triglycerides ≥1.7 mmol/L, FIB-4 was significantly negatively correlated with femoral neck BMD (β = -0.025, 95%CI: -0.048, -0.003), with a significant interaction effect (P = 0.011).

Conclusions: A non-linear association between liver fibrosis and femoral neck BMD was observed in T2DM-MAFLD patients, particularly postmenopausal women and men aged ≥50 years, modulated by serum triglyceride. Hypertriglyceridemia may represent a crucial metabolic risk factor for osteoporosis development in MAFLD patients, suggesting the importance of bone loss screening in this patient population, particularly those with elevated triglycerides.

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来源期刊

Journal of Diabetes Investigation Medicine-Internal Medicine

自引率

9.40%

发文量

218

期刊介绍： Journal of Diabetes Investigation is your core diabetes journal from Asia; the official journal of the Asian Association for the Study of Diabetes (AASD). The journal publishes original research, country reports, commentaries, reviews, mini-reviews, case reports, letters, as well as editorials and news. Embracing clinical and experimental research in diabetes and related areas, the Journal of Diabetes Investigation includes aspects of prevention, treatment, as well as molecular aspects and pathophysiology. Translational research focused on the exchange of ideas between clinicians and researchers is also welcome. Journal of Diabetes Investigation is indexed by Science Citation Index Expanded (SCIE).