Ichikawa Tatsuki, Yamashima Mio, Yamamichi Shinobu, Koike Makiko, Nakano Yusuke, Yajima Hiroyuki, Miyazaki Osamu, Ikeda Tomonari, Okamura Takuma, Komatsu Naohiro, Sugio Sayuri, Yoshino Miruki, Miyaaki Hisamitsu
Department of Gastroenterology, Nagasaki Harbor Medical Center, Japan.
Department of Comprehensive Community Care Systems, Graduate School of Biomedical Sciences, Nagasaki University, Japan.
Intern Med. 2025 May 1;64(9):1296-1302. doi: 10.2169/internalmedicine.4337-24. Epub 2024 Sep 18.
Objective To evaluate the effect of pemafibrate (PEM) on metabolic dysfunction-associated steatotic liver disease (MASLD). Methods We retrospectively evaluated 43 patients with hyperlipidemia and MASLD to determine changes in clinical factors between the start of PEM treatment and 0.5 years later. Using FibroScan, 39 of 43 patients were evaluated for liver stiffness (LS; kPa) and controlled attenuation parameter (CAP; dB/m). None of the patients had decompensated cirrhosis. Results Thirty patients were women, the median age was 66 years old, the median fibrosis-4 (FIB-4) score was 2.52, the median LS was 8.05 kPa, and the median CAP was 280.5 dB/m at the start of PEM treatment. AST, ALT, ALP, γGTP, and triglyceride levels decreased 0.5 years after starting PEM treatment, but FIB-4, LS, and CAP values did not decrease. However, LS decreased in patients with a FIB-4 index ≥1.3 at the start of PEM treatment, whereas it did not change in patients with a FIB-4 index <1.3. Similarly, LS decreased in patients with a value ≥8 kPa at the start of treatment and did not change in those with <8 kPa. The decreased LS group had higher baseline ALT and LS levels and lower ALT levels during 0.5 years of follow-up than the increased LS group. Conclusion At the initiation of PEM treatment, the LS decreased in patients with MASLD complicated by hyperlipidemia and moderate LS (FIB-4>1.3 or LS >8 kPa). Although there is currently no approved treatment for MASLD, PEM may be a viable treatment option for MASLD with mild LS.
目的 评估匹伐他汀（PEM）对代谢功能障碍相关脂肪性肝病（MASLD）的影响。方法 我们回顾性评估了43例高脂血症合并MASLD患者，以确定PEM治疗开始时与0.5年后临床因素的变化。使用FibroScan对43例患者中的39例进行肝脏硬度（LS；kPa）和受控衰减参数（CAP；dB/m）评估。所有患者均无失代偿期肝硬化。结果 PEM治疗开始时，30例为女性，中位年龄为66岁，中位纤维化-4（FIB-4）评分2.52，中位LS为8.05 kPa，中位CAP为280.5 dB/m。开始PEM治疗0.5年后，AST、ALT、ALP、γGTP和甘油三酯水平下降，但FIB-4、LS和CAP值未下降。然而，PEM治疗开始时FIB-4指数≥1.3的患者LS下降，而FIB-4指数<1.3的患者LS未改变。同样，治疗开始时值≥8 kPa的患者LS下降，<8 kPa的患者LS未改变。LS下降组的基线ALT和LS水平高于LS升高组，随访0.5年期间ALT水平低于LS升高组。结论 在开始PEM治疗时，高脂血症合并中度LS（FIB-4>1.3或LS>8 kPa）的MASLD患者的LS下降。虽然目前尚无批准用于MASLD的治疗方法，但PEM可能是轻度LS的MASLD的一种可行治疗选择。
