Gastroenterological Liver Disease Center, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan.
Gastroenterological Liver Disease Center, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan.
Ann Hepatol. 2024 Jul-Aug;29(4):101507. doi: 10.1016/j.aohep.2024.101507. Epub 2024 May 8.
The mechanisms of hepatic fat loss in late-stage metabolic dysfunction-associated fatty liver disease (MASLD) are enigmatic and the prognostic significance of low hepatic fat content (LHF) in chronic liver disease (CLD) is unknown. Proton density fat fraction (PDFF), measured by magnetic resonance imaging (MRI), is considered the most accurate noninvasive method for quantifying hepatic fat content. This study aimed to address these issues by evaluating PDFF.
This is a single-center, retrospective study involving 762 patients with CLD, measuring liver stiffness (LS) using MR elastography and PDFF using MRI. LHF was defined as a PDFF ≤ 2.7 % and hepatic reserve function was assessed using the albumin-bilirubin (ALBI) score. Multivariate analysis explored associations between variables.
LHF was 27 % in the entire cohort, and PDFF was significantly decreased with LS ≥ 5.5 kPa (p < 0.05). On the multivariate analysis, low body mass index and ALBI score were independently associated with LHF (p < 0.05). In advanced CLD (n = 288), ALBI score and PDFF showed a significant negative correlation regardless of etiology (MASLD/non-MASLD: r= -0.613/-0.233), and the prevalence of LHF increased with progression of ALBI grade (p < 0.01 each). In addition, lower PDFF was associated with increased liver-related and all-cause mortality (p < 0.01), and Cox proportional hazards models extracted LHF as an independent prognostic factor, along with ALBI score and hepatocellular carcinoma (p < 0.05 each).
In ACLD, hepatic reserve dysfunction contributed to hepatic fat loss independent of nutritional status, suggesting that LHF may be a poor prognostic factor in all etiologies.
晚期代谢相关脂肪性肝病（MASLD）中肝脂肪丢失的机制尚不清楚，慢性肝病（CLD）中肝脂肪含量低（LHF）的预后意义尚不清楚。磁共振成像（MRI）测量的质子密度脂肪分数（PDFF）被认为是定量肝脂肪含量最准确的无创方法。本研究旨在通过评估 PDFF 来解决这些问题。
这是一项单中心、回顾性研究，纳入了 762 例 CLD 患者，使用磁共振弹性成像测量肝硬度（LS），使用 MRI 测量 PDFF。LHF 的定义为 PDFF≤2.7%，并使用白蛋白-胆红素（ALBI）评分评估肝储备功能。多变量分析探讨了变量之间的关联。
整个队列中 LHF 的比例为 27%，LS≥5.5kPa 时 PDFF 显著降低（p<0.05）。多变量分析显示，低体重指数和 ALBI 评分与 LHF 独立相关（p<0.05）。在晚期 CLD（n=288）中，无论病因如何（MASLD/非 MASLD：r=-0.613/-0.233），ALBI 评分和 PDFF 均呈显著负相关，且随着 ALBI 分级的进展，LHF 的患病率增加（p<0.01 各）。此外，较低的 PDFF 与肝相关和全因死亡率的增加相关（p<0.01），Cox 比例风险模型提取 LHF 作为独立的预后因素，与 ALBI 评分和肝细胞癌一起（p<0.05 各）。
在 ACLD 中，肝储备功能障碍导致肝脂肪丢失，与营养状况无关，提示 LHF 可能是所有病因的不良预后因素。
