Department of Transfusion Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Liver Center, San Raffaele Hospital, Milan, Italy.
Liver Int. 2023 Jul;43(7):1593-1603. doi: 10.1111/liv.15577. Epub 2023 Apr 10.
Metabolic dysfunction (MD)-associated fatty liver disease has been proposed to identify individuals at risk of liver events irrespectively of the contemporary presence of other liver diseases. The aim of this study was to examine the impact of MD in patients cured of chronic hepatis C (CHC).
We analysed data from a real-life cohort of 2611 Italian patients cured of CHC with direct antiviral agents and advanced liver fibrosis, without HBV/HIV, transplantation and negative for hepatocellular carcinoma (HCC) history (age 61.4 ± 11.8 years, 63.9% males, median follow-up 34, 24-40 months). Information about ultrasonographic steatosis (US) after sustained virological response was available in 1978.
MD affected 58% of patients, diagnosed due to the presence of diabetes (MD-diabetes, 19%), overweight without diabetes (MD-overweight, 37%) or multiple metabolic abnormalities without overweight and diabetes (MD-metabolic, 2%). MD was more frequent than and not coincident with US (32% MD-only, 23% MD-US and 13% US-only). MD was associated with higher liver stiffness (p < 0.05), particularly in patients with MD-diabetes and MD-only subgroups, comprising older individuals with more advanced metabolic and liver disease (p < 0.05). At Cox proportional hazard multivariable analysis, MD was associated with increased risk of HCC (HR 1.97, 95% CI 1.27-3.04; p = 0.0023). Further classification according to diagnostic criteria improved risk stratification (p < 0.0001), with the highest risk observed in patients with MD-diabetes. Patients with MD-only appeared at highest risk since the sustained virological response achievement (p = 0.008), with a later catch-up of those with combined MD-US, whereas US-only was not associated with HCC.
MD is more prevalent than US in patients cured of CHC with advanced fibrosis and identifies more accurately individuals at risk of developing HCC.
代谢功能障碍（MD）相关的脂肪性肝病已被提出，用于识别无论当前是否存在其他肝病，都存在发生肝脏事件风险的个体。本研究旨在检查 MD 在慢性丙型肝炎（CHC）治愈患者中的影响。
我们分析了来自意大利一个真实队列的 2611 名接受直接抗病毒药物治疗且有晚期纤维化、无乙型肝炎/丙型肝炎病毒（HBV/HCV）、肝移植和无肝细胞癌（HCC）病史的 CHC 治愈患者的数据（年龄 61.4±11.8 岁，男性占 63.9%，中位随访时间为 34 个月，24-40 个月）。在持续病毒学应答后，超声检查脂肪变性（US）的信息可在 1978 年获得。
58%的患者存在 MD，其诊断依据为糖尿病（MD-糖尿病，19%）、无糖尿病的超重（MD-超重，37%）或无超重和糖尿病的多种代谢异常（MD-代谢，2%）。MD 的发生频率高于且与 US 不同（32% MD 单独发生，23% MD-US 同时发生，13% US 单独发生）。MD 与较高的肝硬度相关（p<0.05），特别是在 MD-糖尿病和 MD 单独亚组的患者中，这些患者年龄较大，代谢和肝脏疾病更严重（p<0.05）。在 Cox 比例风险多变量分析中，MD 与 HCC 风险增加相关（HR 1.97，95%CI 1.27-3.04；p=0.0023）。根据诊断标准进一步分类可改善风险分层（p<0.0001），MD-糖尿病患者的风险最高。MD 单独发生的患者自持续病毒学应答以来风险最高（p=0.008），随后 MD-US 合并发生的患者风险逐渐升高，而 US 单独发生与 HCC 无关。
MD 在有晚期纤维化的 CHC 治愈患者中比 US 更常见，并且更准确地识别出发生 HCC 的风险个体。
