Krishnan Arunkumar, Mukherjee Diptasree
Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, United States.
Department of Supportive Oncology, Atrium Health Levine Cancer, Charlotte, NC 28204, United States.
World J Hepatol. 2025 Mar 27;17(3):103835. doi: 10.4254/wjh.v17.i3.103835.
Metabolic dysfunction-associated steatotic liver disease, previously known as nonalcoholic fatty liver disease (NAFLD), is becoming increasingly common and is associated with significant morbidity and mortality related to both liver and non-liver issues. In its early stages, NAFLD is characterized by immune cell dysregulation, which suggests that immune-targeted therapies could be a viable treatment option for nonalcoholic steatohepatitis. A recent study by Zhu . investigated the role of autoantibodies in metabolic dysfunction-associated steatotic liver disease at various histological stages. While the research provided valuable insights, several methodological concerns are noted, which include the study's retrospective design, a limited panel of autoantibodies, and a lack of a prospective study design that adequately controls for confounding factors such as age, comorbidities and lifestyle. Furthermore, the interpretation of positive antinuclear antibodies as evidence of autoimmune involvement in NAFLD is questioned due to the possibility of nonspecific immune responses. Recommendations to improve the study's design include conducting prospective studies, implementing more detailed antibody profiling, and adjusting for demographic and clinical factors. Future studies should address these issues to improve the clinical relevance and credibility of findings related to autoimmunity in NAFLD.
代谢功能障碍相关脂肪性肝病，以前称为非酒精性脂肪性肝病（NAFLD），正变得越来越普遍，并且与肝脏和非肝脏问题相关的显著发病率和死亡率有关。在其早期阶段，NAFLD的特征是免疫细胞失调，这表明免疫靶向疗法可能是非酒精性脂肪性肝炎的一种可行治疗选择。朱等人最近的一项研究调查了自身抗体在不同组织学阶段的代谢功能障碍相关脂肪性肝病中的作用。虽然该研究提供了有价值的见解，但也指出了几个方法学问题，包括研究的回顾性设计、有限的自身抗体检测组，以及缺乏前瞻性研究设计来充分控制年龄、合并症和生活方式等混杂因素。此外，由于存在非特异性免疫反应的可能性，将抗核抗体阳性解释为自身免疫参与NAFLD的证据受到质疑。改进该研究设计的建议包括进行前瞻性研究、实施更详细的抗体谱分析，以及调整人口统计学和临床因素。未来的研究应解决这些问题，以提高与NAFLD自身免疫相关研究结果的临床相关性和可信度。
