Esposito Michele, Buono Raffaele, Angeli Paolo, Girardi Paolo, Di Pascoli Marco
Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine - DIMED, University of Padova, Padova, Italy.
Department of Environmental Sciences, Informatics and Statistics, Ca' Foscari, University of Venice, Italy.
Dig Liver Dis. 2025 Apr;57(4):869-876. doi: 10.1016/j.dld.2024.11.021. Epub 2024 Dec 12.
The global prevalence of Metabolic Dysfunction-Associated Liver Disease is dramatically increasing with the diffusion of cardiometabolic risk factors (CMRFs). The aim of the present study was to assess the natural course of liver cirrhosis, in terms of decompensation, development of hepatocellular carcinoma and mortality, in relation to the presence of CMRFs (type 2 diabetes mellitus, obesity, arterial hypertension, low HDL levels, hypertriglyceridemia).
667 patients with liver cirrhosis (50 with CMRFs and without non-metabolic aetiological factors, 167 with non-metabolic aetiological factors and without CMRFs, and 450 with both non-metabolic aetiological factors and at least one CMRF) followed at the University and General Hospital of Padua, Italy, from 1998 to 2022, were included.
No difference in the occurrence of cirrhosis decompensating events and development of hepatocellular carcinoma was observed, whereas patients in the metabolic or mixed group had 4-3-fold higher all-cause mortality and significantly lower 3-years survival compared to patients in the non-metabolic group, despite a better liver function at enrolment. Hypertriglyceridemia and low HDL levels were the less prevalent CMRFs, but those associated with the highest risk of cirrhosis decompensation. Hypertriglyceridemia was also associated with an increased risk of mortality. Arterial hypertension was associated with a reduced risk of cirrhosis decompensation, but a higher risk of mortality.
Compared to patients without CMRFs, those with CMRFs had similar rates of liver cirrhosis decompensation but higher overall mortality. Hypertriglyceridemia was associated with a high risk of both liver decompensation and death.
随着心脏代谢危险因素（CMRFs）的扩散，代谢功能障碍相关肝病的全球患病率正在急剧上升。本研究的目的是评估肝硬化的自然病程，包括失代偿、肝细胞癌的发生和死亡率，与CMRFs（2型糖尿病、肥胖、动脉高血压、低高密度脂蛋白水平、高甘油三酯血症）的存在之间的关系。
纳入了1998年至2022年在意大利帕多瓦大学综合医院随访的667例肝硬化患者（50例有CMRFs且无非代谢性病因，167例有非代谢性病因且无CMRFs，450例有非代谢性病因且至少有一种CMRF）。
在肝硬化失代偿事件的发生和肝细胞癌的发展方面未观察到差异，然而，代谢组或混合组的患者全因死亡率比非代谢组患者高4至3倍，且3年生存率显著更低，尽管入组时肝功能更好。高甘油三酯血症和低高密度脂蛋白水平是较不常见的CMRFs，但与肝硬化失代偿的最高风险相关。高甘油三酯血症也与死亡风险增加相关。动脉高血压与肝硬化失代偿风险降低相关，但与死亡风险较高相关。
与无CMRFs的患者相比，有CMRFs的患者肝硬化失代偿率相似，但总体死亡率更高。高甘油三酯血症与肝失代偿和死亡的高风险相关。
