马来西亚一个多民族城市人口中血液透析患者的代谢功能障碍相关脂肪性肝病（MAFLD）和晚期肝纤维化

Metabolic dysfunction-associated fatty liver disease (MAFLD) and advanced liver fibrosis among hemodialysis patients in a multiethnic urban population in Malaysia.

作者信息

Wong Wei-Kei, Chan Wah-Kheong, Ganapathy Shubash Shander, Lim Soo-Kun

机构信息

Department of Medicine, University of Malaya, Faculty of Medicine, Kuala Lumpur, Malaysia.

Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

出版信息

Semin Dial. 2023 Mar;36(2):107-116. doi: 10.1111/sdi.13117. Epub 2022 Jul 12.

DOI:10.1111/sdi.13117

PMID:35821201

Abstract

BACKGROUND

Metabolic-dysfunction-associated fatty liver disease (MAFLD) and end stage kidney disease (ESKD) are complications of the metabolic syndrome. Our aim is to study the prevalence of MAFLD and advanced liver fibrosis and the associated factors among hemodialysis patients in a multiracial urban population in Malaysia.

METHODS

A cross-sectional study of hemodialysis patients from 10 hemodialysis centers was used. FibroTouch examination was performed on all patients. Fatty liver was diagnosed based on ultrasound attenuation parameter ≥248 dB/m while advanced liver fibrosis was diagnosed based on liver stiffness measurement ≥10 kPa.

RESULTS

This study included 447 hemodialysis patients (median age 59 [50-67], male 55%, Chinese 61%, Malay 20%, Indian 18%). Dialysis vintage was 49 (22-93) months. The prevalence of MAFLD was 43.4%. Independent factors associated with MAFLD were elevated waist circumference (aOR = 10.1, 95% CI = 5.3-19.4, p < 0.001), normal platelet count (aOR = 3.1, 95% CI = 1.3-7.3, p < 0.05), low HDL cholesterol (aOR = 2.3, 95% CI = 1.3-4.2, p < 0.01), elevated fasting blood sugar (aOR = 2.3, 95% CI = 1.3-3.8, p < 0.01), elevated hsCRP (aOR = 2.2, 95% CI = 1.2-4.0, p < 0.01), and advanced liver fibrosis (aOR = 3.0, 95% CI = 1.6-5.6, p < 0.001). The prevalence of advanced liver fibrosis was 25.5%. Independent factors associated with advanced liver fibrosis were male gender (aOR = 1.8, 95% CI = 1.0-3.0, p < 0.05), elevated waist circumference (aOR = 2.0, 95% CI = 1.0-4.0, p < 0.05), low platelet count (aOR = 5.4, 95% CI = 2.7-11.0, p < 0.001), elevated GGT (aOR = 5.0, 95% CI = 2.9-8.8, p < 0.001), and MAFLD (aOR = 3.2, 95% CI = 1.7-5.9, p < 0.001).

CONCLUSION

A high prevalence of MAFLD and advanced liver fibrosis was observed among hemodialysis patients. Nephrologists should consider a more proactive approach in diagnosing MAFLD and/or advanced liver fibrosis in hemodialysis patients.

摘要

背景

代谢功能障碍相关脂肪性肝病（MAFLD）和终末期肾病（ESKD）是代谢综合征的并发症。我们的目的是研究马来西亚一个多民族城市人群中血液透析患者MAFLD和晚期肝纤维化的患病率及其相关因素。

方法

采用对来自10个血液透析中心的血液透析患者进行的横断面研究。对所有患者进行FibroTouch检查。基于超声衰减参数≥248dB/m诊断脂肪肝，基于肝脏硬度测量≥10kPa诊断晚期肝纤维化。

结果

本研究纳入447例血液透析患者（中位年龄59[50 - 67]岁，男性占55%，华裔占61%，马来裔占20%，印度裔占18%）。透析龄为49（22 - 93）个月。MAFLD的患病率为43.4%。与MAFLD相关的独立因素包括腰围增加（调整后比值比[aOR]=10.1，95%置信区间[CI]=5.3 - 19.4，p<0.001）、血小板计数正常（aOR = 3.1，95%CI = 1.3 - 7.3，p<0.05）、高密度脂蛋白胆固醇降低（aOR = 2.3，95%CI = 1.3 - 4.2，p<0.01）、空腹血糖升高（aOR = 2.3，95%CI = 1.3 - 3.8，p<0.01）、高敏C反应蛋白升高（aOR = 2.2，95%CI = 1.2 - 4.0，p<0.01）以及晚期肝纤维化（aOR = 3.0，95%CI = 1.6 - 5.6，p<0.001）。晚期肝纤维化的患病率为25.5%。与晚期肝纤维化相关的独立因素包括男性（aOR = 1.8，95%CI = 1.0 - 3.0，p<0.05）、腰围增加（aOR = 2.0，95%CI = 1.0 - 4.0，p<0.05）、血小板计数降低（aOR = 5.4，95%CI = 2.7 - 11.0，p<0.001）、γ-谷氨酰转移酶升高（aOR = 5.0，95%CI = 2.9 - 8.8，p<0.001）以及MAFLD（aOR = 3.2，95%CI = 1.7 - 5.9，p<0.001）。