一大群日本健康检查参与者中脂肪性肝病类别的临床特征
Clinical Characteristics of Steatotic Liver Disease Categories in a Large Cohort of Japanese Health Checkup Participants.
作者信息
Kamada Yoshihiro, Fujii Hideki, Suzuki Yuichiro, Sawada Koji, Tatsuta Miwa, Maeshiro Tatsuji, Tobita Hiroshi, Tsutsumi Tsubasa, Akahane Takemi, Hasebe Chitomi, Kawanaka Miwa, Kessoku Takaomi, Eguchi Yuichiro, Syokita Hayashi, Nakajima Atsushi, Kamada Tomoari, Yoshiji Hitoshi, Kawaguchi Takumi, Sakugawa Hiroshi, Morishita Asahiro, Masaki Tsutomu, Ohmura Takumi, Watanabe Toshio, Yoda Yoshioki, Enomoto Nobuyuki, Ono Masafumi, Fuyama Kanako, Okada Kazufumi, Nishimoto Naoki, Ito Yoichi M, Takahashi Hirokazu, Sumida Yoshio
机构信息
Department of Advanced Metabolic Hepatology, Osaka University Graduate School of Medicine 1-7, Suita, Osaka, Japan.
Department of Hepatology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Osaka, Japan.
出版信息
Gastro Hep Adv. 2024 Aug 10;3(8):1148-1156. doi: 10.1016/j.gastha.2024.08.006. eCollection 2024.
BACKGROUND AND AIMS
The clinical characteristics and risk factors involved in the development of liver fibrosis in the subtypes of steatotic liver disease (SLD) remain unknown. We examined the clinical characteristics of SLD subtypes using a large Japanese cohort.
METHODS
We performed a cross-sectional analysis (total n = 108,446). In this cohort, SLD was diagnosed by ultrasonography. Individuals with none of the cardiometabolic risk factors were excluded.
RESULTS
According to their nonalcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) status based on the database, participants with cardiometabolic criteria were allocated to the MASLD, MASLD with increased alcohol intake (MetALD), and alcohol-associated liver disease (ALD) with metabolic dysfunction groups. Of 30,857 subjects with SLD, 21,488 (69.6%) had NAFLD, and 20,922 (67.8%) had MASLD. There were few differences in the clinical characteristics between NAFLD and MASLD. After adjustment for clinical variables, we found that male patients with MetALD [odds ratio (OR) 2.26; 95% confidence interval (CI) 1.87-2.84] and ALD with metabolic dysfunction (OR 3.92; 95% CI 2.85-5.39) had a significantly higher risk for advanced liver fibrosis (diagnosed by Fibrosis-4 (FIB-4) index >2.67) compared to those with MASLD. In female patients with ALD, metabolic dysfunction (OR 5.80; 95% CI 2.51-13.4) and systemic blood pressure of ≥130 mmHg were significant risk factors for high FIB-4 (males: OR 3.38, 95% CI 2.51-4.55; females: OR 4.34, 95% CI 2.66-7.07, < .001).
CONCLUSION
Alcohol intake and systolic blood pressure are independent contributors to liver fibrosis progression assessed by FIB-4 in SLD.
背景与目的
脂肪性肝病（SLD）各亚型中肝纤维化发生发展所涉及的临床特征及危险因素尚不清楚。我们使用一个大型日本队列研究了SLD各亚型的临床特征。
方法
我们进行了一项横断面分析（共108446例）。在该队列中，通过超声诊断SLD。排除无任何心血管代谢危险因素的个体。
结果
根据数据库中的非酒精性脂肪性肝病（NAFLD）和代谢功能障碍相关脂肪性肝病（MASLD）状态，符合心血管代谢标准的参与者被分配到MASLD组、酒精摄入量增加的MASLD组（MetALD）和伴有代谢功能障碍的酒精性肝病（ALD）组。在30857例SLD患者中，21488例（69.6%）患有NAFLD，20922例（67.8%）患有MASLD。NAFLD和MASLD之间的临床特征差异不大。在对临床变量进行调整后，我们发现，与MASLD患者相比，患有MetALD的男性患者[比值比（OR）2.26；95%置信区间（CI）1.87 - 2.84]和伴有代谢功能障碍的ALD患者（OR 3.92；95%CI 2.85 - 5.39）发生晚期肝纤维化（通过Fibrosis-4（FIB-4）指数>2.67诊断）的风险显著更高。在患有ALD的女性患者中，代谢功能障碍（OR 5.80；95%CI 2.51 - 13.4）和收缩压≥130 mmHg是FIB-4升高的显著危险因素（男性：OR 3.38，95%CI 2.51 - 4.55；女性：OR 4.34，95%CI 2.66 - 7.07，P <.001）。
结论
酒精摄入量和收缩压是通过FIB-4评估的SLD中肝纤维化进展的独立影响因素。
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