降脂治疗对家族性高胆固醇血症患者 MASLD 指标的影响。

The effect of lipid-lowering treatment on indices of MASLD in familial hypercholesterolemia patients.

机构信息

Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.

出版信息

Clin Nutr. 2024 Dec;43(12):84-91. doi: 10.1016/j.clnu.2024.10.020. Epub 2024 Oct 16.

DOI:10.1016/j.clnu.2024.10.020

PMID:39437569

Abstract

BACKGROUND & AIMS: The effect of lipid-lowering treatment (LLT) on metabolic dysfunction associated steatotic liver disease (MASLD) is unclear. This is relevant for patients with familial hypercholesterolemia (FH) who are on lifelong LLT. We aimed to evaluate the effect of LLT on MASLD indices in this population.

METHODS

Patients with at least possible diagnosis of FH were included into the Hellenic FH Registry (HELLAS-FH) registry. We analyzed the effect of statin monotherapy, statin/ezetimibe and statin/ezetimibe/proprotein convertase subtilisin/kexin 9 inhibitors (PCSK9i) on MASLD indices, i.e., original triglyceride-glucose index (TyGO) and triglyceride-glucose index (TyG). We compared changes of TyG and TyGO before any treatment and after at least one year of stable LLT.

RESULTS

We included 1289 patients: n = 569 in the statin monotherapy group (mean age = 51 ± 15 years, 52.7 % males), n = 629 in the statin/ezetimibe group (52 ± 14 years, 51.8 %), and n = 91 in the statin/ezetimibe/PCSK9i group (54 ± 13 years, 58.2 %). Compared with baseline, TyGO and TyG decreased significantly following statin monotherapy (8.61 vs 8.49 and 4.65 vs 4.59, respectively, both p < 0.01), statin/ezetimibe (8.59 vs 8.41 and 4.64 vs 4.55, respectively, both p < 0.01) and statin/ezetimibe/PCSK9i (8.79 vs 8.55 and 4.74 vs 4.62, respectively, both p < 0.01). There was no difference regarding the change of TyGO and TyG between groups after adjusting for baseline levels. A greater percentage of patients in the statin/ezetimibe and statin/ezetimibe/PCSK9i groups exhibited TyGO-defined MASLD resolution compared with statin monotherapy (p < 0.05). After adjustment for possible confounders, LLT was significantly associated with MASLD resolution.

CONCLUSIONS

MASLD indices were significantly improved in all LLT groups in FH patients. Statin/ezetimibe and statin/ezetimibe/PCSK9i were associated with greater TyGO-defined MASLD resolution compared with statin monotherapy.

摘要

背景与目的

降脂治疗（LLT）对代谢功能障碍相关脂肪性肝病（MASLD）的影响尚不清楚。这对于接受终身 LLT 的家族性高胆固醇血症（FH）患者来说很重要。我们旨在评估 LLT 对该人群 MASLD 指标的影响。

方法

将至少可能诊断为 FH 的患者纳入希腊 FH 登记处（HELLAS-FH）登记处。我们分析了他汀类药物单药治疗、他汀类药物/依折麦布和他汀类药物/依折麦布/前蛋白转化酶枯草溶菌素 9 抑制剂（PCSK9i）对 MASLD 指标（即原始甘油三酯-葡萄糖指数（TyGO）和甘油三酯-葡萄糖指数（TyG））的影响。我们比较了在开始任何治疗之前和至少一年稳定 LLT 后 TyG 和 TyGO 的变化。

结果

我们纳入了 1289 名患者：他汀类药物单药治疗组 n=569（平均年龄 51±15 岁，52.7%为男性），他汀类药物/依折麦布组 n=629（52±14 岁，51.8%），他汀类药物/依折麦布/PCSK9i 组 n=91（54±13 岁，58.2%）。与基线相比，他汀类药物单药治疗（8.61 与 8.49 和 4.65 与 4.59，均 p<0.01）、他汀类药物/依折麦布（8.59 与 8.41 和 4.64 与 4.55，均 p<0.01）和他汀类药物/依折麦布/PCSK9i（8.79 与 8.55 和 4.74 与 4.62，均 p<0.01）后 TyGO 和 TyG 均显著降低。调整基线水平后，各组间 TyGO 和 TyG 的变化无差异。与他汀类药物单药治疗相比，他汀类药物/依折麦布和他汀类药物/依折麦布/PCSK9i 组有更多的患者 TyGO 定义的 MASLD 缓解（p<0.05）。调整可能的混杂因素后，LLT 与 MASLD 缓解显著相关。