Li Wei, Jiang Lina, Li Meiling, Lin Chen, Zhu Li, Zhao Bokang, Liu Yisi, Li Yan, Jiang Yiyun, Liu Shuhong, Liang Ping, Niu Junqi, Zhao Jingmin
Department of Pathology and Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, P. R. China.
Medical School of Chinese PLA, Beijing, P. R. China.
Gastroenterol Rep (Oxf). 2025 Jun 16;13:goaf056. doi: 10.1093/gastro/goaf056. eCollection 2025.
Metabolic dysfunction-associated steatotic liver disease (MASLD) has been proposed to replace the term of non-alcoholic fatty liver disease (NAFLD). To investigate the effect of MASLD on liver fibrosis and validate the clinical utility of MASLD criteria, differences in disease severity and clinical outcomes between MASLD and NAFLD were compared in a biopsy-proven pediatric cohort. The retrospective clinical data of 427 children with biopsy-proven steatotic liver between 2010 and 2021 were consecutively collected and categorized into three distinct subgroups of MASLD-only, NAFLD-only, and MASLD-NAFLD according to the diagnostic guidelines. Patients with MASLD-only and MASLD-NAFLD had more features of metabolic disorders, with higher level of triglycerides but lower level of high-density lipoprotein cholesterol than NAFLD-only. The proportion of significant fibrosis was highest in MASLD-only patients (68.0%), followed by those with MASLD-NAFLD and NAFLD-only (43.3% and 19.4%, respectively; <0.001). More steatohepatitis was presented in MASLD-NAFLD group than the other two groups (66.1% vs 30.8% vs 22.6%, <0.001). Multivariate regression revealed that children with MASLD-only had 5.8-fold greater risk of significant fibrosis than those with NAFLD-only (=0.001). After a median follow-up of 83 months, 14 of 427 patients developed clinical outcomes. Kaplan-Meier curves indicated no difference in the cumulative incidence of clinical events between the groups (log-rank, =0.073). Children in MASLD group tended to have concomitant with severe liver fibrosis and related metabolic diseases compared to those with NAFLD-only in pediatric cohort. Thus, the redefinition of MASLD may improve the detection of children with severe disease that need early intervention.
代谢功能障碍相关脂肪性肝病（MASLD）已被提议取代非酒精性脂肪性肝病（NAFLD）这一术语。为了研究MASLD对肝纤维化的影响并验证MASLD标准的临床实用性，在一个经活检证实的儿科队列中比较了MASLD和NAFLD在疾病严重程度和临床结局方面的差异。连续收集了2010年至2021年间427例经活检证实为脂肪性肝病儿童的回顾性临床数据，并根据诊断指南将其分为仅MASLD、仅NAFLD和MASLD-NAFLD三个不同亚组。仅MASLD和MASLD-NAFLD患者有更多代谢紊乱特征，与仅NAFLD患者相比，甘油三酯水平更高但高密度脂蛋白胆固醇水平更低。显著纤维化比例在仅MASLD患者中最高（68.0%），其次是MASLD-NAFLD患者和仅NAFLD患者（分别为43.3%和19.4%；<0.001）。MASLD-NAFLD组出现脂肪性肝炎的比例高于其他两组（66.1%对30.8%对22.6%，<0.001）。多因素回归显示，仅MASLD儿童发生显著纤维化的风险比仅NAFLD儿童高5.8倍（=0.001）。中位随访83个月后，427例患者中有14例出现临床结局。Kaplan-Meier曲线表明各组间临床事件累积发生率无差异（对数秩检验，=0.073）。与儿科队列中仅NAFLD儿童相比，MASLD组儿童往往伴有严重肝纤维化和相关代谢疾病。因此，MASLD的重新定义可能会改善对需要早期干预的重症儿童的检测。
