Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, NSW, 2145, Australia.
Gastroenterology and Hepatology Unit, Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
Hepatol Int. 2024 Jun;18(3):964-972. doi: 10.1007/s12072-024-10673-7. Epub 2024 May 8.
Diagnostic criteria for metabolic dysfunction-associated steatotic liver disease (MASLD) have been proposed but not yet validated. This study aimed to compare the diagnostic accuracy of the MASLD definition with the existing criteria for metabolic dysfunction-associated fatty liver disease (MAFLD) in identifying patients with significant fibrosis.
The analysis included a total of 8317 individuals who had complete biochemical and liver ultrasonography data from the National Health and Nutrition Examination Survey (2017-2020). In this study, significant fibrosis (≥ F2) was determined by a median liver stiffness of ≥ 8.0 kPa. To identify independent factors associated with significant fibrosis, multivariable logistic regression analyses were applied.
MAFLD (OR 3.44; 95% CI 2.88-4.12; P < 0.0001) has a trend for stronger and independent association with significant fibrosis compared to MASLD (OR 2.63; 95% CI 2.22-3.11; P < 0.0001). Non-MASLD MAFLD is independently associated with a 14.28-fold higher odds of significant fibrosis compared to non-MAFLD MASLD. The sensitivity for detecting significant fibrosis for MAFLD and MASLD was 76.23% vs 69.94%, respectively. The performance of MAFLD remains consistent in a sub-analysis of patients with no or mild alcohol intake.
The definition of MAFLD provides a more precise identification of individuals who have both fatty liver and significant fibrosis, assessed by non-invasive tests.
代谢相关脂肪性肝病（MAFLD）相关的代谢功能障碍性脂肪性肝病（MASLD）的诊断标准已经提出，但尚未得到验证。本研究旨在比较 MASLD 定义与现有的代谢功能障碍相关脂肪性肝病（MAFLD）标准在识别有显著纤维化的患者方面的诊断准确性。
这项分析共纳入了来自全国健康和营养调查（2017-2020 年）的 8317 名具有完整生化和肝脏超声数据的个体。本研究中，通过中位数肝脏硬度值≥8.0kPa 来确定显著纤维化（≥F2）。为了确定与显著纤维化相关的独立因素，应用多变量逻辑回归分析。
与 MASLD 相比，MAFLD（OR 3.44；95%CI 2.88-4.12；P<0.0001）与显著纤维化的关联具有更强的趋势且独立。与非 MAFLD MASLD 相比，非 MASLD MAFLD 与显著纤维化的相关性高出 14.28 倍。MAFLD 和 MASLD 检测显著纤维化的敏感性分别为 76.23%和 69.94%。在没有或轻度饮酒的患者亚组分析中，MAFLD 的表现仍然一致。
MAFLD 的定义通过非侵入性检查更准确地识别出既有脂肪肝又有显著纤维化的个体。
