Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain.
SeLiver Group, Instituto de Biomedicina de Sevilla, Seville, Spain.
J Gastroenterol. 2024 Jul;59(7):586-597. doi: 10.1007/s00535-024-02098-8. Epub 2024 Apr 15.
MASLD can manifest as hepatocellular damage, which can result in mild elevation of aminotransferases. However, in some patients, MASLD presents with cholestatic pattern.
To assess the impact of the biochemical pattern on the natural course of MASLD, including liver damage in histology, the accuracy of non-invasive tests(NITs), and prognosis.
Multicenter study enrolling 2156 patients with biopsy-proven MASLD, who were classified based on their[ALT/ULN)]/[(ALP/ULN)] levels at the time of biopsy: (a) hepatocellular pattern(H), > 5; (b) mixed pattern(M),2-5; (c) cholestatic pattern(C), < 2.
(a) histological evaluation of the single components of NAS, MASH, and fibrosis; (b) NITs and transient elastography assessing advanced fibrosis; (c) prognosis determined by the appearance of decompensated cirrhosis and death.
Out of the 2156 patients, 22.9% exhibited the H-pattern, whilst 31.7% exhibited the C-pattern. Severe steatosis, ballooning, lobular inflammation, and MASH (56.4% H vs. 41.9% M vs. 31.9% C) were more common in H-pattern (p = 0.0001),whilst C-pattern was linked to cirrhosis (5.8% H vs. 5.6% M vs. 10.9% C; p = 0.0001). FIB-4(0.74(95% CI 0.69-0.79) vs. 0.83 (95% CI 0.80-0.85); p = 0.005) and Hepamet Fibrosis Score(0.77 (95% CI 0.69-0.85) vs. 0.84 (95% CI 0.80-0.87); p = 0.044)exhibited lower AUROCs in the H-pattern. The C-pattern[HR 2.37 (95% CI 1.12-5.02); p = 0.024], along with age, diabetes, and cirrhosis were independently associated with mortality. Most patients maintained their initial biochemical pattern during the second evaluation.
The H-pattern exhibited greater necro-inflammation in the histology than the C-pattern, whereas the latter showed more cirrhosis. The accuracy of NITs in detecting fibrosis was decreased in H-pattern. The occurrence of decompensated events and mortality was predominant in C-pattern. Therefore, identifying MASLD phenotypes based on the biochemical presentation could be relevant for clinical practice.
MASLD 可表现为肝细胞损伤，导致氨基转移酶轻度升高。然而，在一些患者中，MASLD 表现为胆汁淤积模式。
评估生化模式对 MASLD 自然病程的影响，包括组织学肝损伤、非侵入性检测（NITs）的准确性和预后。
多中心研究纳入 2156 例经活检证实的 MASLD 患者，根据活检时[ALT/ULN)]/[(ALP/ULN)]水平进行分类：(a) 肝细胞模式（H），>5；(b) 混合模式（M），2-5；(c) 胆汁淤积模式（C），<2。
2156 例患者中，22.9%表现为 H 型，31.7%表现为 C 型。严重脂肪变性、气球样变、肝小叶炎症和 MASH（56.4% H 型 vs. 41.9% M 型 vs. 31.9% C 型）在 H 型中更为常见（p=0.0001），而 C 型与肝硬化有关（5.8% H 型 vs. 5.6% M 型 vs. 10.9% C 型；p=0.0001）。FIB-4（0.74（95%CI 0.69-0.79）vs. 0.83（95%CI 0.80-0.85）；p=0.005）和 Hepamet 纤维化评分（0.77（95%CI 0.69-0.85）vs. 0.84（95%CI 0.80-0.87）；p=0.044）在 H 型中的 AUROC 较低。C 型[HR 2.37（95%CI 1.12-5.02）；p=0.024]，以及年龄、糖尿病和肝硬化与死亡率独立相关。大多数患者在第二次评估时保持了初始的生化模式。
H 型组织学上的坏死炎症比 C 型更严重，而后者则表现出更多的肝硬化。NITs 检测纤维化的准确性在 H 型中降低。失代偿事件和死亡率主要发生在 C 型。因此，根据生化表现确定 MASLD 表型可能与临床实践相关。
