以社区为中心的代谢功能障碍相关脂肪性肝病疾病严重程度评估
Community-centered Disease Severity Assessment of Metabolic Dysfunction-associated Fatty Liver Disease.
作者信息
Huang Jee-Fu, Tsai Pei-Chien, Yeh Ming-Lun, Huang Chung-Feng, Huang Ching-I, Lee Mei-Hsuan, Hsu Po-Yau, Wang Chih-Wen, Wei Yu-Ju, Liang Po-Cheng, Lin Yi-Hung, Hsieh Meng-Hsuan, Yang Jeng-Fu, Hsieh Ming-Yen, Jang Tyng-Yuan, Bair Ming-Jong, Lin Zu-Yau, Dai Chia-Yen, Yu Ming-Lung, Chuang Wan-Long
机构信息
Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.
Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung.
出版信息
J Clin Transl Hepatol. 2023 Oct 28;11(5):1061-1068. doi: 10.14218/JCTH.2022.00103S. Epub 2023 May 24.
BACKGROUND AND AIMS
Disease severity across the different diagnostic categories of metabolic dysfunction-associated fatty liver disease (MAFLD) remains elusive. This study assessed the fibrosis stages and features of MAFLD between different items. We also aimed to investigate the associations between advanced fibrosis and risk factors.
METHODS
This multicenter cross-sectional study enrolled adults participating in liver disease screening in the community. Patients were stratified following MAFLD diagnostic criteria, to group A (395 patients) for type 2 diabetes, group B (1,818 patients) for body mass index (BMI)>23 kg/m, and group C (44 patients) for BMI≤23 kg/m with at least two metabolic factors. Advanced fibrosis was defined as a fibrosis-4 index>2.67.
RESULTS
Between 2009 and 2020, 1,948 MAFLD patients were recruited, including 478 with concomitant liver diseases. Advanced fibrosis was observed in 125 patients. A significantly larger proportion of patients in group C (25.0%) than in group A (7.6%) and group B (5.8%) had advanced fibrosis (<0.01). Logistic regression analysis found that hepatitis B virus (HBV)/hepatitis C virus (HCV) coinfection (odds ratio [OR]: 12.14, 95% confidence interval [CI]: 4.04-36.52; <0.01), HCV infection (OR: 7.87, 95% CI: 4.78-12.97; <0.01), group C (OR: 6.00, 95% CI: 2.53-14.22; <0.01), and TC/LDL-C (OR: 1.21, 95% CI: 1.06-1.38; <0.01) were significant predictors of advanced fibrosis.
CONCLUSIONS
A higher proportion of lean MAFLD patients with metabolic abnormalities had advanced fibrosis. HCV infection was significantly associated with advanced fibrosis.
背景与目的
代谢功能障碍相关脂肪性肝病（MAFLD）不同诊断类别之间的疾病严重程度仍不明确。本研究评估了不同类别MAFLD的纤维化阶段及特征。我们还旨在探究晚期纤维化与危险因素之间的关联。
方法
这项多中心横断面研究纳入了参与社区肝病筛查的成年人。患者按照MAFLD诊断标准进行分层，2型糖尿病患者归入A组（395例患者），体重指数（BMI）>23 kg/m²的患者归入B组（1818例患者），BMI≤23 kg/m²且至少有两个代谢因素的患者归入C组（44例患者）。晚期纤维化定义为纤维化-4指数>2.67。
结果
2009年至2020年期间，共招募了1948例MAFLD患者，其中478例伴有其他肝脏疾病。125例患者出现晚期纤维化。C组患者中晚期纤维化的比例（25.0%）显著高于A组（7.6%）和B组（5.8%）（P<0.01）。逻辑回归分析发现，乙型肝炎病毒（HBV）/丙型肝炎病毒（HCV）合并感染（比值比[OR]：12.14，95%置信区间[CI]：4.04-36.52；P<0.01）、HCV感染（OR：7.87，95% CI：4.78-12.97；P<0.01）、C组（OR：6.00，95% CI：2.53-14.22；P<0.01）以及总胆固醇/低密度脂蛋白胆固醇（TC/LDL-C）（OR：1.21，95% CI：1.06-1.38；P<0.01）是晚期纤维化的显著预测因素。
结论
代谢异常的瘦型MAFLD患者中晚期纤维化的比例更高。HCV感染与晚期纤维化显著相关。
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