脂肪性肝病预测心血管疾病和晚期肝纤维化：一项具有 20 年随访的社区居民队列研究。

Steatotic liver disease predicts cardiovascular disease and advanced liver fibrosis: A community-dwelling cohort study with 20-year follow-up.

机构信息

Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea.

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.

出版信息

Metabolism. 2024 Apr;153:155800. doi: 10.1016/j.metabol.2024.155800. Epub 2024 Jan 22.

DOI:10.1016/j.metabol.2024.155800

PMID:38266957

Abstract

BACKGROUND

Steatotic liver disease (SLD) has emerged as new nomenclature to increase awareness and reflect the pathophysiology of the disease better. We investigated the risk of advanced fibrosis and cardiovascular disease (CVD) in SLD using data derived from a Korean prospective cohort.

METHODS

We defined SLD using the fatty liver index (FLI) and identified advanced fibrosis with the age-adjusted Fibrosis-4 Index. SLD was further subcategorized into metabolic dysfunction-associated SLD (MASLD), MASLD with increased alcohol intake (MetALD), and alcohol-associated liver disease (ALD).

FINDINGS

The Ansung-Ansan cohort of the Korean Genome and Epidemiology study, following 9497 participants from 2002 to 2020, included 3642 (38.3%) with MASLD, 424 (4.5%) with MetALD, and 207 (2.1%) with ALD. During the median follow-up of 17.5 years, CVD risk was higher in those with MASLD (hazard ratio [HR], 1.27; 95% confidence interval [CI], 1.12-1.45; P < 0.001), MetALD (HR, 1.88; 95% CI, 1.33-2.65; P < 0.001), and ALD (HR, 1.95; 95% CI, 1.01-3.77; P < 0.001) than in those without SLD, after adjusting for conventional risk factors. Notably, CVD risk was higher in the MetALD than in the MASLD group (P = 0.027). In the MASLD group, the number of cardiometabolic risk factors (CMRFs) correlated positively with CVD risk (HR, 1.34; 95% CI, 1.24-1.45; P < 0.001 for trend). Among the CMRFs, hypertension (HR, 1.94; 95% CI, 1.63-2.31; P < 0.001) was the predominant contributor to CVD. The MASLD (HR, 1.39; 95% CI, 1.25-1.55; P < 0.001), MetALD (HR, 1.75; 95% CI, 1.38-2.23; P < 0.001), and ALD (HR, 2.00; 95% CI, 1.30-3.07; P = 0.002) groups had a higher risk of advanced fibrosis than did the non-SLD group (P < 0.001 for trend).

INTERPRETATION

Our study provides new insight into hepatic and cardiovascular outcomes related to SLD subtypes. The risk of CVD increased in the order of no SLD, MASLD, and MetALD. The SLD subcategories, considering CMRFs and alcohol intake, outperformed traditional fatty liver categorizations in predicting CVD risk. The proposed SLD terminology could impact clinical practice, warranting further exploration of the heterogeneity of clinical outcomes among SLD subtypes.

摘要

背景

脂肪性肝病（SLD）已成为新的命名法，旨在提高对该疾病的认识并更好地反映其病理生理学。我们使用来自韩国前瞻性队列的数据，研究了 SLD 患者发生晚期纤维化和心血管疾病（CVD）的风险。

方法

我们使用脂肪肝指数（FLI）定义 SLD，并使用年龄调整的纤维化 4 指数（Fibrosis-4 Index）确定晚期纤维化。进一步将 SLD 分为代谢功能障碍相关 SLD（MASLD）、代谢功能障碍相关 SLD 伴酒精摄入增加（MetALD）和酒精性肝病（ALD）。

结果

韩国基因组和流行病学研究的 Ansung-Ansan 队列，从 2002 年到 2020 年随访了 9497 名参与者，其中 3642 名（38.3%）患有 MASLD，424 名（4.5%）患有 MetALD，207 名（2.1%）患有 ALD。在中位随访 17.5 年期间，与无 SLD 相比，MASLD（风险比[HR]，1.27；95%置信区间[CI]，1.12-1.45；P<0.001）、MetALD（HR，1.88；95%CI，1.33-2.65；P<0.001）和 ALD（HR，1.95；95%CI，1.01-3.77；P<0.001）患者的 CVD 风险更高，在调整了传统危险因素后。值得注意的是，与 MASLD 相比，MetALD 患者的 CVD 风险更高（P=0.027）。在 MASLD 组中，心血管代谢危险因素（CMRFs）的数量与 CVD 风险呈正相关（HR，1.34；95%CI，1.24-1.45；P<0.001）。在 CMRFs 中，高血压（HR，1.94；95%CI，1.63-2.31；P<0.001）是 CVD 的主要危险因素。MASLD（HR，1.39；95%CI，1.25-1.55；P<0.001）、MetALD（HR，1.75；95%CI，1.38-2.23；P<0.001）和 ALD（HR，2.00；95%CI，1.30-3.07；P=0.002）患者发生晚期纤维化的风险高于非 SLD 患者（P<0.001）。

结论

本研究提供了有关 SLD 亚型与肝和心血管结局相关的新见解。CVD 风险的增加顺序为无 SLD、MASLD 和 MetALD。考虑到 CMRFs 和酒精摄入的 SLD 亚类在预测 CVD 风险方面优于传统的脂肪肝分类。拟议的 SLD 术语可能会影响临床实践，需要进一步探索 SLD 亚型之间临床结局的异质性。