Zhang Qian, Wang Yutao, Liu Si, Zhu Shengtao, Li Peng, Wu Shanshan
Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University; State Key Laboratory of Digestive Health; National Clinical Research Center for Digestive Diseases, Beijing, 100050, China.
Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University; State Key Laboratory of Digestive Health; National Clinical Research Center for Digestive Diseases, Beijing, 100050, China.
Dig Liver Dis. 2025 Mar;57(3):744-752. doi: 10.1016/j.dld.2024.11.002. Epub 2024 Nov 24.
To examine the mortality risk associated with metabolic dysfunction-associated steatotic liver disease (MASLD), MASLD type, lean/non-lean MASLD and different cardiometabolic risk factors (CMRFs) in patients with inflammatory bowel disease (IBD) based on a long-term prospective cohort.
Prevalent IBD patients at baseline who were free of alcoholic liver disease, cancer and hepatitis B/C virus seropositive were included (N=4622). MASLD, MASLD type [pure MASLD, MASLD with increased alcohol intake (MetALD)], lean/non-lean MASLD and CMRFs at baseline were defined according to the latest criteria proposed by AASLD and EASL. Primary outcome was all-cause mortality. Cox proportional hazard model was used to examine the association.
Overall, 1,763 (38.1%) were diagnosed with MASLD. During a median of 13.3-year follow-up, 451 all-cause deaths were identified. Compared with IBD-only patients, those with MASLD had a 58% excess risk of mortality (HR=1.58, 95%CI:1.07-2.32). Furthermore, as number of CMRFs increased in MASLD patients, mortality risk was significantly increased (P=0.005), with a 85% and 83% higher risk in MASLD with 3 CMRFs (HR=1.85, 95%CI:1.20-2.85) and ≥4 CMRFs (HR=1.83, 95%CI:1.16-2.89) versus IBD-only patients. Specifically, similar elevated mortality risk was observed in either pure MASLD (HR= 1.62, 95%CI:1.09-2.43) or MetALD (HR=2.03, 95%CI:1.24-3.32). Moreover, the excess mortality risk was both indicated in lean (HR=3.14, 95%CI:1.57-6.29) and non-lean MASLD (HR=1.67, 95%CI:1.12-2.48).
MASLD, either pure MASLD or MetALD, as well as lean/non-lean MASLD, is associated with increased mortality risk in IBD patients, with greater risk as number of cardiometabolic risk factors increased and evidently higher risk in lean MASLD patients.
基于一项长期前瞻性队列研究，探讨炎症性肠病（IBD）患者中与代谢功能障碍相关脂肪性肝病（MASLD）、MASLD类型、消瘦/非消瘦型MASLD及不同心血管代谢危险因素（CMRFs）相关的死亡风险。
纳入基线时无酒精性肝病、癌症且乙肝/丙肝病毒血清学阴性的IBD患者（N = 4622）。根据美国肝病研究学会（AASLD）和欧洲肝脏研究学会（EASL）提出的最新标准定义基线时的MASLD、MASLD类型[单纯MASLD、酒精摄入量增加的MASLD（代谢性酒精性脂肪性肝病）]、消瘦/非消瘦型MASLD及CMRFs。主要结局为全因死亡率。采用Cox比例风险模型检验相关性。
总体而言，1763例（38.1%）被诊断为MASLD。在中位13.3年的随访期间，共确定451例全因死亡。与仅患IBD的患者相比，患MASLD的患者死亡风险高出58%（HR = 1.58，95%CI：1.07 - 2.32）。此外，随着MASLD患者CMRFs数量的增加，死亡风险显著增加（P = 0.005），与仅患IBD的患者相比，有3个CMRFs的MASLD患者死亡风险高85%（HR = 1.85，95%CI：1.20 - 2.85），≥4个CMRFs的MASLD患者死亡风险高83%（HR = 1.83，95%CI：1.16 - 2.89）。具体而言，单纯MASLD（HR = 1.62，95%CI：1.09 - 2.43）或代谢性酒精性脂肪性肝病（HR = 2.03，95%CI：1.24 - 3.32）均观察到类似的死亡风险升高。此外，消瘦型（HR = 3.14，95%CI：1.57 - 6.29）和非消瘦型MASLD（HR = 1.67，95%CI：1.12 - 2.48）均存在额外的死亡风险。
MASLD，无论是单纯MASLD还是代谢性酒精性脂肪性肝病，以及消瘦/非消瘦型MASLD，均与IBD患者死亡风险增加相关，随着心血管代谢危险因素数量的增加风险更大，且消瘦型MASLD患者风险明显更高。
