Inukai Yosuke, Ito Takanori, Yokoyama Shinya, Yamamoto Kenta, Imai Norihiro, Ishizu Yoji, Honda Takashi, Shimizu Tatsuji, Hattori Masashi, Takeyama Tomoaki, Ando Yusuke, Nishikawa Takahiro, Morita Kiyoshi, Toyoda Hidenori, Ishigami Masatoshi, Kawashima Hiroki
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Gastroenterology, Japan Community Health Care Organization Kani Tono Hospital, Kani, Japan.
J Dig Dis. 2024 Nov-Dec;25(11-12):685-693. doi: 10.1111/1751-2980.13325. Epub 2025 Jan 13.
To identify the diagnostic criteria for metabolic dysfunction-associated steatotic liver disease (MASLD) related to liver fibrosis and to characterize patients with cryptogenic steatotic liver disease (SLD) (non-MASLD) among those previously diagnosed with nonalcoholic fatty liver disease (NAFLD).
This multicenter retrospective study included 511 patients diagnosed with NAFLD via liver biopsy, and the prevalence of MASLD was assessed based on the diagnostic criteria. Patients were divided into those who met the MASLD criteria and those who did not, and the characteristics of advanced fibrosis and associated cardiometabolic factors were evaluated.
Of the 475 patients with NAFLD, 458 (96.4%) met the criteria for MASLD, showing a high overlap between classical NAFLD and MASLD populations. Severe fibrosis was observed, regardless of the number of cardiometabolic factors. Hypertension and diabetes mellitus significantly contributed to advanced fibrosis (≥ F3), with odds ratio of 1.92 and 2.00 (95% confidence interval of 1.17-3.16 and 1.22-3.28, respectively; both p < 0.01) on multivariate analysis. The other seventeen (3.6%) patients did not meet the diagnostic criteria for MASLD. Among them, seven had significant fibrosis and a high fibrosis-4 index.
Diabetes mellitus and hypertension are key metabolic factors associated with advanced fibrosis. Some cases, classified as cryptogenic SLD, also exhibit significant fibrosis. Consequently, identifying high-risk patients, including those undergoing noninvasive tests for fibrosis, is crucial.
确定与肝纤维化相关的代谢功能障碍相关脂肪性肝病（MASLD）的诊断标准，并对先前诊断为非酒精性脂肪性肝病（NAFLD）的隐源性脂肪性肝病（SLD）（非MASLD）患者进行特征描述。
这项多中心回顾性研究纳入了511例经肝活检诊断为NAFLD的患者，并根据诊断标准评估MASLD的患病率。患者被分为符合MASLD标准的患者和不符合该标准的患者，并评估了晚期纤维化的特征及相关的心脏代谢因素。
在475例NAFLD患者中，458例（96.4%）符合MASLD标准，表明经典NAFLD人群与MASLD人群之间存在高度重叠。无论心脏代谢因素的数量如何，均观察到严重纤维化。高血压和糖尿病对晚期纤维化（≥F3）有显著影响，多因素分析时的比值比分别为1.92和2.00（95%置信区间分别为1.17 - 3.16和1.22 - 3.28；均p < 0.01）。另外17例（3.6%）患者不符合MASLD的诊断标准。其中，7例有显著纤维化且纤维化-4指数较高。
糖尿病和高血压是与晚期纤维化相关的关键代谢因素。一些被归类为隐源性SLD的病例也表现出显著纤维化。因此，识别高危患者，包括那些正在接受纤维化无创检测的患者，至关重要。
