代谢功能障碍和酒精相关肝病专家共识德尔菲小组：临床实践中的机遇与挑战

An Expert Consensus Delphi Panel in Metabolic Dysfunction- and Alcohol-associated Liver Disease: Opportunities and Challenges in Clinical Practice.

作者信息

Diaz Luis Antonio, Ajmera Veeral, Arab Juan Pablo, Huang Daniel Q, Hsu Cynthia, Lee Brian P, Louvet Alexandre, Thiele Maja, Tavaglione Federica, Tincopa Monica, Pose Elisa, Adams Leon A, Alazawi William, Arrese Marco, Bataller Ramon, Duseja Ajay, Liangpunsakul Suthat, Lucey Michael R, Mathurin Philippe, Mellinger Jessica, Nakajima Atsushi, Ratziu Vlad, Reau Nancy, Rinella Mary E, Thursz Mark, Wong Vincent Wai-Sun, Kamath Patrick S, Loomba Rohit

机构信息

MASLD Research Center, Division of Gastroenterology and Hepatology, University of California San Diego, San Diego, California; Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.

MASLD Research Center, Division of Gastroenterology and Hepatology, University of California San Diego, San Diego, California.

出版信息

Clin Gastroenterol Hepatol. 2025 Apr 30. doi: 10.1016/j.cgh.2025.02.017.

DOI:10.1016/j.cgh.2025.02.017

PMID:40315973

Abstract

BACKGROUND & AIMS: Metabolic dysfunction- and alcohol-associated liver disease (MetALD) is a recently defined entity for individuals with liver steatosis, metabolic dysfunction, and increased alcohol intake. However, the current definition of MetALD poses multiple challenges in clinical practice and research. In this Delphi consensus, we provide practical recommendations for the clinical assessment and management of MetALD to address current clinical challenges in MetALD.

METHODS

We used a modified Delphi process, including 2 surveys involving a panel of 28 experts from 10 countries spanning 4 continents. We predefined consensus as requiring an ≥80% agreement.

RESULTS

The panel reached consensus on 28 statements. Recommendations emphasize the importance of a comprehensive assessment of patients with presumed MetALD, including the quantification of alcohol intake using validated questionnaires and the use of objective biomarkers of alcohol use, such as phosphatidylethanol. The need to reassess metabolic risk factors and liver disease after a period of alcohol abstinence was highlighted to distinguish the primary driver of liver injury. Noninvasive tests were recommended to assess liver disease severity, whereas routine liver biopsy was deemed unnecessary unless other diagnoses were suspected. Comprehensive management strategies should involve multidisciplinary care focusing on lifestyle modifications, alcohol reduction or cessation, weight loss, and exercise. Finally, the panel identified significant gaps in knowledge, advocating for standardized research protocols, longitudinal studies, exploration of pathophysiological mechanisms to inform precision medicine approaches, and the validation of quantitative alcohol biomarkers for identifying MetALD.

CONCLUSIONS

This Delphi consensus provides clear recommendations for the clinical assessment and management of MetALD, addressing the unique challenges posed by this condition.

摘要

背景与目的

代谢功能障碍和酒精相关肝病（MetALD）是最近针对患有肝脂肪变性、代谢功能障碍和酒精摄入量增加的个体定义的一种疾病。然而，目前MetALD的定义在临床实践和研究中带来了多重挑战。在本次德尔菲共识中，我们为MetALD的临床评估和管理提供实用建议，以应对MetALD当前的临床挑战。

方法

我们采用了改良的德尔菲流程，包括2项调查，涉及来自4大洲10个国家的28位专家组成的小组。我们将共识预定义为需要≥80%的一致意见。

结果

该小组就28项声明达成了共识。建议强调对疑似MetALD患者进行全面评估的重要性，包括使用经过验证的问卷对酒精摄入量进行量化，以及使用酒精使用的客观生物标志物，如磷脂酰乙醇。强调在一段时间戒酒之后需要重新评估代谢风险因素和肝病，以区分肝损伤的主要驱动因素。建议采用非侵入性检测来评估肝病严重程度，而常规肝活检除非怀疑有其他诊断否则被认为不必要。综合管理策略应包括多学科护理，重点是生活方式改变、减少或戒酒、减肥和运动。最后，该小组确定了知识方面的重大差距，主张采用标准化研究方案、纵向研究、探索病理生理机制以指导精准医学方法，以及验证用于识别MetALD的定量酒精生物标志物。