代谢功能障碍相关脂肪性肝病及其合并症对代谢功能障碍相关脂肪性肝病-2型糖尿病混合队列中认知及健康相关生活质量结局的影响

Impact of Metabolic Dysfunction-Associated Steatotic Liver Disease and Associated Comorbidities on Cognitive and Health-Related Quality-of-Life Outcomes in a Mixed Metabolic Dysfunction-Associated Steatotic Liver Disease-Type 2 Diabetes Mellitus Cohort.

作者信息

Perez-Diaz-Del-Campo Nuria, Castelnuovo Gabriele, Ferro Arianna, Caviglia Gian Paolo, Rosso Chiara, Dileo Eleonora, Guariglia Marta, Armandi Angelo, Saba Francesca, Saracco Giorgio Maria, Barutta Federica, Beccuti Guglielmo, Gruden Gabriella, Younossi Zobair M, Bugianesi Elisabetta

机构信息

Department of Medical Sciences, University of Turin, Turin, Italy.

Gastroenterology Unit, Città della Salute e della Scienza-Molinette Hospital, Turin, Italy.

出版信息

Am J Gastroenterol. 2025 Jun 11;120(8):1779-1790. doi: 10.14309/ajg.0000000000003594.

DOI:10.14309/ajg.0000000000003594

PMID:40498052

Abstract

INTRODUCTION

Metabolic dysfunction-associated steatotic liver disease (MASLD) coexists with multiple comorbidities that contribute to impaired vascular function, worsening cognitive impairment, and quality of life. The aim of this study was to evaluate the impact of MASLD and related comorbidities on cognitive function and health-related quality of life (HRQoL).

METHODS

A total of 601 overweight/obese patients with MASLD and/or type 2 diabetes mellitus were included. Liver stiffness (LS) measurement and steatosis were assessed by transient elastography and controlled attenuation parameter (CAP), respectively. Cognitive function and HRQoL were evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status and Short Form (36) Health Survey (SF-36) questionnaires.

RESULTS

MASLD-related comorbidities were found to significantly and clinically affect cognitive function and HRQoL. Patients with severe steatosis (CAP ≥ 300 dB/m, n = 378) exhibited median cognitive scores falling into the abnormal range ( P = 0.056), with statistically significant lower scores in physical functioning ( P < 0.001), vitality ( P = 0.011), general health ( P = 0.001), and immediate memory ( P = 0.034), as well as a trend toward lower visuospatial/construction scores ( P = 0.058) than CAP <300 dB/m. Among patients with significant or high LS (LS ≥ 8 kPa, n = 69), lower physical functioning ( P < 0.001), higher physical limitations ( P = 0.004), and worse general health ( P = 0.011) were observed compared with those with LS < 8 kPa. In the multivariate adjusted analyses, CAP ≥ 300 dB/m was significantly associated with cognitive impairment (odds ratio: 1.42, 95% confidence interval 1.0; 2.0, P = 0.045), whereas LS ≥ 8 kPa was associated with higher physical limitations (odds ratio: 1.9, 95% confidence interval 1.1; 3.2, P = 0.019).

DISCUSSION

Our findings highlight the relationship between MASLD severity and impairment in cognitive function and HRQoL, underscoring its multifactorial nature. Specifically, severe hepatic steatosis may be a risk factor of cognitive decline, whereas significant or high LS seems to greatly affect HRQoL.

摘要

引言

代谢功能障碍相关脂肪性肝病（MASLD）与多种合并症共存，这些合并症会导致血管功能受损、认知障碍加重以及生活质量下降。本研究的目的是评估MASLD及相关合并症对认知功能和健康相关生活质量（HRQoL）的影响。

方法

共纳入601例超重/肥胖的MASLD和/或2型糖尿病患者。分别通过瞬时弹性成像和受控衰减参数（CAP）评估肝脏硬度（LS）测量值和脂肪变性情况。使用可重复神经心理状态评估量表和简短健康调查问卷（SF-36）对认知功能和HRQoL进行评估。

结果

发现与MASLD相关的合并症对认知功能和HRQoL有显著的临床影响。重度脂肪变性（CAP≥300 dB/m，n = 378）的患者认知得分中位数处于异常范围（P = 0.056），其身体功能（P < 0.001）、活力（P = 0.011）、总体健康状况（P = 0.001）和即时记忆（P = 0.034）得分在统计学上显著更低，并且与CAP < 300 dB/m的患者相比，视觉空间/构建得分有降低趋势（P = 0.058）。在LS显著升高或升高（LS≥8 kPa，n = 69）的患者中，与LS < 8 kPa的患者相比，观察到身体功能更低（P < 0.001）、身体限制更高（P = 0.004）以及总体健康状况更差（P = 0.011）。在多变量调整分析中，CAP≥300 dB/m与认知障碍显著相关（比值比：1.42，95%置信区间1.0；2.0，P = 0.045），而LS≥8 kPa与更高的身体限制相关（比值比：1.9，95%置信区间1.1；3.2，P = 0.019）。