Villarroel Carolina, Karim Gres, Sehmbhi Mantej, Debroff Jake, Weisberg Ilan, Dinani Amreen
Department of Medicine, Mount Sinai Beth Israel Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York.
Division of Gastroenterology, NewYork-Presbyterian Brooklyn Methodist Hospital, New York, New York.
Gastro Hep Adv. 2023 Sep 23;3(1):122-127. doi: 10.1016/j.gastha.2023.09.008. eCollection 2024.
The large global population of patients with metabolic dysfunction-associated steatotic liver disease (MASLD) has recently been shown to have an association with chronic kidney disease (CKD) due to a host of proposed mechanisms, one of which being lipoprotein dysmetabolism. Furthermore, metabolic comorbidities have been concurrently prevalent in MASLD and CKD independently. This study aimed at analyzing risk and predictive traits among an obese population for both MASLD and CKD.
A retrospective chart review of 546 obese patients with a diagnosis of either MASLD or metabolic dysfunction-associated steatohepatitis between January 2020 and June 2021 was performed. Markers of liver and kidney function in addition to demographic data and renoprotective medications were recorded. Both univariable and multivariable linear regression analyses were performed to understand possible associations between MASLD markers, renal function, and markers of metabolic derangements.
Univariate analysis revealed that increased age ( < .001), elevated alanine aminotransferase (defined as alanine aminotransferase ≥ 30 IU/L, = .01), low albumin ( = .011), and increasing fibrosis-4 (FIB-4) ( = .005) were statistically associated with a reduced renal function. A reduction in glomerular filtration was associated with an increase in FIB-4 (effect size [beta] of a one-unit increase in glomerular filtration on FIB-4 = -0.013, < .001) in univariate linear regression. In multivariate linear regression, type 2 diabetes (T2D) was independently associated with increased liver fibrosis (effect size of T2D on FIB-4 = 0.387925, < .02).
Our study shows that in a patient population with obesity and a diagnosis of MASLD, advanced fibrosis is independently associated with reduced renal function.
最近有研究表明，全球大量代谢功能障碍相关脂肪性肝病（MASLD）患者因多种潜在机制与慢性肾脏病（CKD）相关，其中之一是脂蛋白代谢异常。此外，代谢合并症在MASLD和CKD中各自独立普遍存在。本研究旨在分析肥胖人群中MASLD和CKD的风险及预测特征。
对2020年1月至2021年6月期间诊断为MASLD或代谢功能障碍相关脂肪性肝炎的546例肥胖患者进行回顾性病历审查。记录肝功能和肾功能指标以及人口统计学数据和肾脏保护药物。进行单变量和多变量线性回归分析，以了解MASLD指标、肾功能和代谢紊乱指标之间的可能关联。
单变量分析显示，年龄增加（<.001）、丙氨酸氨基转移酶升高（定义为丙氨酸氨基转移酶≥30 IU/L，=.01）、白蛋白降低（=.011）和纤维化-4（FIB-4）升高（=.005）与肾功能降低在统计学上相关。在单变量线性回归中，肾小球滤过率降低与FIB-4升高相关（肾小球滤过率每增加一个单位对FIB-4的效应大小[β]=-0.013，<.001）。在多变量线性回归中，2型糖尿病（T2D）与肝纤维化增加独立相关（T2D对FIB-4的效应大小=0.387925，<.02）。
我们的研究表明，在诊断为MASLD的肥胖患者群体中，晚期纤维化与肾功能降低独立相关。
