在真实世界的初级医疗环境中对有进展为晚期肝纤维化风险的代谢功能障碍相关脂肪性肝病（MASLD）的诊断：一项横断面研究

Diagnosis of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) at Risk for Advanced Fibrosis in a Real-World Primary Care Setting: A Cross-Sectional Study.

作者信息

Schreiner Andrew D, Zhang Jingwen, Bolus Vincent, Marsden Justin, Bays Chloe, Mohamed Ahmed, Moran William P, Mauldin Patrick D, Gebregziabher Mulugeta, Rockey Don C

机构信息

Department of Medicine, Medical University of South Carolina, Charleston, USA.

Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA.

出版信息

J Gen Intern Med. 2025 Jul 7. doi: 10.1007/s11606-025-09659-4.

DOI:10.1007/s11606-025-09659-4

PMID:40624322

Abstract

BACKGROUND

Recent guidelines provide recommendations for diagnosing metabolic dysfunction-associate steatotic liver disease (MASLD) when hepatic steatosis is seen radiographically, but questions remain as to when to pursue imaging for the evidence of hepatic steatosis.

OBJECTIVE

We aimed to test the performance of traditional MASLD case-finding cues for detecting MASLD at-risk for advanced fibrosis.

DESIGN

We performed a cross-sectional study of electronic health record data from a large primary care clinic between 2012 and 2021.

PATIENTS

Patients with abdominal imaging and inputs for Fibrosis-4 Index (FIB-4) calculation.

MAIN MEASURES

We examined the performance characteristics of type 2 diabetes mellitus (T2DM), a BMI ≥ 30 kg/m, or an alanine aminotransferase (ALT) ≥ 40 IU/L for detecting the primary outcome of MASLD at-risk for advanced fibrosis. We also tested the optimal thresholds of BMI and ALT for detecting the primary outcome.

KEY RESULTS

The sample included 9000 patients of whom 1683 (19%) patients had MASLD and 696 (8%) had MASLD and an indeterminate-risk or greater for advanced fibrosis. T2DM, BMI ≥ 30 kg/m, and ALT ≥ 40 IU/L identified 45%, 48%, and 49% of patients with MASLD at-risk for advanced fibrosis. An ALT ≥ 31 IU/L had the highest AUC for detecting MASLD at-risk for advanced fibrosis, and the union of T2DM, BMI ≥ 30 kg/m, or ALT ≥ 31 IU/L had a sensitivity of 89%.

CONCLUSIONS

While historical cues for MASLD case finding had low sensitivities individually, the union of these three, simple, broadly available signals had a high sensitivity for MASLD at-risk for advanced fibrosis.

摘要

背景

近期指南针对在影像学上发现肝脂肪变性时诊断代谢功能障碍相关脂肪性肝病（MASLD）提供了建议，但对于何时进行影像学检查以获取肝脂肪变性的证据仍存在疑问。

目的

我们旨在测试传统MASLD病例发现线索在检测有晚期纤维化风险的MASLD方面的性能。

设计

我们对2012年至2021年间一家大型初级保健诊所的电子健康记录数据进行了横断面研究。

患者

有腹部影像学检查结果且有用于计算纤维化-4指数（FIB-4）的数据的患者。

主要测量指标

我们检查了2型糖尿病（T2DM）、体重指数（BMI）≥30 kg/m²或丙氨酸氨基转移酶（ALT）≥40 IU/L在检测有晚期纤维化风险的MASLD主要结局方面的性能特征。我们还测试了BMI和ALT用于检测主要结局的最佳阈值。

关键结果

样本包括9000名患者，其中1683名（19%）患者患有MASLD，696名（8%）患者患有MASLD且晚期纤维化风险不确定或更高。T2DM、BMI≥30 kg/m²和ALT≥40 IU/L分别识别出45%、48%和49%有晚期纤维化风险的MASLD患者。ALT≥31 IU/L在检测有晚期纤维化风险的MASLD方面具有最高的曲线下面积（AUC），T2DM、BMI≥30 kg/m²或ALT≥31 IU/L联合使用时灵敏度为89%。