Tavaglione Federica, Amangurbanova Maral, Yang Alexander H, Tincopa Monica A, Ajmera Veeral, Richards Lisa, Butcher Christian, Hernandez Christie, Madamba Egbert, Singh Seema, Bettencourt Ricki, Sirlin Claude B, Loomba Rohit
MASLD Research Center, Division of Gastroenterology and Hepatology, University of California at San Diego, La Jolla, California, USA.
Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, California, USA.
Aliment Pharmacol Ther. 2025 Mar;61(6):1043-1054. doi: 10.1111/apt.18506. Epub 2025 Jan 17.
The current subclassification of steatotic liver disease (SLD) relies on validated questionnaires, such as Alcohol Use Disorders Identification Test (AUDIT) and Lifetime Drinking History (LDH), which, while useful, are impractical and lack precision for their use in routine clinical practice. Phosphatidylethanol (PEth) is a quantitative, objective alcohol biomarker with high sensitivity and specificity.
To assess the diagnostic accuracy of PEth for differentiating metabolic dysfunction and alcohol-associated liver disease (MetALD) from metabolic dysfunction-associated steatotic liver disease (MASLD) in a large, population-based, prospective, multiethnic cohort of individuals with overweight or obesity.
This is a cross-sectional analysis of a prospective study including 374 adults with overweight or obesity residing in Southern California who had SLD as defined by MRI-PDFF ≥ 5%. The clinical research visit included medical history, biochemical and PEth testing, standardised validated questionnaires (including AUDIT and LDH), physical examination, and advanced imaging using MRI-PDFF and MRE.
Among 374 adults with SLD, the prevalence of MASLD, MetALD, and ALD was 90.1%, 6.4%, and 3.5%, respectively. PEth had a robust diagnostic accuracy in the detection of MetALD (AUROC 0.81, 95%CI 0.73-0.89) and the Youden cut-off was 25 ng/mL. In head-to-head comparative efficacy analysis, PEth was both statistically and clinically superior to all previously used indirect alcohol biomarkers for diagnosing MetALD, including aspartate aminotransferase/alanine aminotransferase ratio, mean corpuscular volume, gamma glutamyltransferase, and ALD/NAFLD index (p < 0.05).
PEth outperforms previously used non-invasive tests in differentiating MetALD from MASLD and has the potential to change clinical practice by enhancing the subclassification of SLD.
目前脂肪性肝病（SLD）的亚分类依赖于经过验证的问卷，如酒精使用障碍识别测试（AUDIT）和终生饮酒史（LDH），这些问卷虽然有用，但在日常临床实践中不切实际且缺乏精确性。磷脂酰乙醇（PEth）是一种定量、客观的酒精生物标志物，具有高敏感性和特异性。
在一个基于人群的大型前瞻性多民族超重或肥胖个体队列中，评估PEth区分代谢功能障碍和酒精相关肝病（MetALD）与代谢功能障碍相关脂肪性肝病（MASLD）的诊断准确性。
这是一项对前瞻性研究的横断面分析，研究对象为居住在南加州的374名超重或肥胖成年人，他们经磁共振成像-质子密度脂肪分数（MRI-PDFF）≥5%确诊为SLD。临床研究访视包括病史采集、生化和PEth检测、标准化验证问卷（包括AUDIT和LDH）、体格检查以及使用MRI-PDFF和磁共振弹性成像（MRE）进行的高级成像检查。
在374名SLD成年患者中，MASLD、MetALD和酒精性肝病（ALD）的患病率分别为90.1%、6.4%和3.5%。PEth在检测MetALD方面具有较强的诊断准确性（曲线下面积[AUC]为0.81，95%置信区间[CI]为0.73-0.89），尤登指数截断值为25 ng/mL。在直接比较疗效分析中，PEth在诊断MetALD方面在统计学和临床上均优于所有先前使用的间接酒精生物标志物，包括天冬氨酸转氨酶/丙氨酸转氨酶比值、平均红细胞体积、γ-谷氨酰转移酶和ALD/非酒精性脂肪性肝病（NAFLD）指数（p<0.05）。
在区分MetALD和MASLD方面，PEth优于先前使用的非侵入性检测方法，并且有可能通过加强SLD的亚分类来改变临床实践。
