慢性乙型肝炎患者中代谢功能障碍相关脂肪性肝病与肝脏硬度变化之间的关联
The Association Between Metabolic Dysfunction-Associated Steatotic Liver Disease and Change in Liver Stiffness in Patients With Chronic Hepatitis B.
作者信息
Patmore Lesley A, van Eekhout Kirsi, Koc Özgür M, de Knegt Robert J, Janssen Harry L A, Brouwer Willem P, Kramer Matthijs, Honkoop Pieter, de Bruijne Joep, Boland Greet J, Postma Douwe F, Blokzijl Hans, de Man Robert A, Takkenberg R Bart, Sonneveld Milan J
机构信息
Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, the Netherlands.
出版信息
Liver Int. 2025 Mar;45(3):e70042. doi: 10.1111/liv.70042.
BACKGROUND AND AIMS
Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with an increased risk of liver-related events in patients with chronic hepatitis B (CHB), possibly by accelerating fibrosis progression. Therefore, we studied the influence of MASLD on liver stiffness measurement (LSM) kinetics in CHB patients.
METHODS
We conducted a multicenter retrospective cohort study of CHB patients with at least two LSM with FibroScan. We studied the absolute change in LSM and the change in LSM stage from the first LSM to the most recent LSM among CHB patients with MASLD compared to patients without MASLD.
RESULTS
We analysed 1055 CHB patients; 259 (28.0%) had MASLD. Patients with MASLD had a higher first and last LSM (6.1 vs. 5.2 kPa and 5.6 vs. 4.7 kPa, p < 0.001), were significantly less likely to achieve a decrease in LSM stage (52.8% vs. 74% p < 0.001) and were more likely to experience an increase in LSM stage (19.3% vs. 13.6%, p = 0.035) during follow-up. 417 (39.5%) patients initiated antiviral therapy (AVT) which was associated with a decline in LSM (p < 0.001). However, patients with MASLD who were treated were less likely to decrease in LSM stage (52.4% vs. 77.0%, p < 0.001) and were more likely to experience an increase in LSM stage (23.5% vs. 12.8%, p = 0.021) despite AVT.
CONCLUSION
Presence of MASLD was independently associated with higher LSM in untreated CHB patients and with less decline in LSM after initiation of AVT. Furthermore, CHB patients with MASLD were more likely to experience an increase in LSM despite AVT.
背景与目的
代谢功能障碍相关脂肪性肝病（MASLD）与慢性乙型肝炎（CHB）患者肝脏相关事件风险增加有关，可能是通过加速肝纤维化进展。因此，我们研究了MASLD对CHB患者肝脏硬度值（LSM）动态变化的影响。
方法
我们对至少进行过两次FibroScan测量LSM的CHB患者开展了一项多中心回顾性队列研究。我们研究了与无MASLD的患者相比，有MASLD的CHB患者从首次LSM到最近一次LSM的LSM绝对变化以及LSM分期变化。
结果
我们分析了1055例CHB患者；259例（28.0%）有MASLD。有MASLD的患者首次和末次LSM值更高（分别为6.1 vs. 5.2 kPa和5.6 vs. 4.7 kPa，p < 0.001），在随访期间达到LSM分期降低的可能性显著更低（52.8% vs. 74%，p < 0.001），且更有可能经历LSM分期升高（19.3% vs. 13.6%，p = 0.035）。417例（39.5%）患者开始抗病毒治疗（AVT），这与LSM降低相关（p < 0.001）。然而，接受治疗的有MASLD的患者LSM分期降低的可能性更小（52.4% vs. 77.0%，p < 0.001），且尽管接受了AVT，但经历LSM分期升高的可能性更大（23.5% vs. 12.8%，p = 0.021）。
结论
在未治疗的CHB患者中，MASLD的存在与更高的LSM独立相关，且在开始AVT后LSM降低较少。此外，尽管接受了AVT，但有MASLD的CHB患者更有可能经历LSM升高。
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