Adams Leon A, Kemp William W, Muller Kate R, Powell Elizabeth E, Roberts Stuart K, Bertot Luis Calzadilla, Best Stephanie, Deed Gary, Emery Jon D, Hocking Samantha L, Jones Graham R, Lubel John S, Sheils Sinead, Twigg Stephen M, Watts Gerald F, George Jacob
University of Western Australia, Perth, WA.
Sir Charles Gairdner Hospital, Perth, WA.
Med J Aust. 2025 Sep 1;223(5):268-276. doi: 10.5694/mja2.70008. Epub 2025 Jul 28.
Metabolic dysfunction-associated fatty liver disease (MAFLD) is common. This evidence-based consensus statement summary provides recommendations for the assessment and monitoring of adults with MAFLD in primary care.
Adults with type 2 diabetes, obesity or two or more other metabolic risk factors should be tested for MAFLD. Hepatic steatosis should be evaluated using ultrasound, whereas the presence and complications of type 2 diabetes and obesity should be assessed according to current Australian guidelines. Cardiovascular disease, chronic kidney disease and obstructive sleep apnoea are common in people with MAFLD and should be considered as part of a holistic health assessment. Alternative causes of hepatic steatosis, including excess alcohol consumption, must be considered, and patients with elevated serum aminotransferase levels should be tested for hepatitis B and C infection and iron overload. The risk of advanced liver fibrosis requires assessment using the Fibrosis-4 (FIB-4) Index; a low score (< 1.3) is associated with a more than 95% negative predictive value for advanced liver fibrosis. People with an indeterminate FIB-4 score (between 1.3 and 2.7) should undergo second-line assessment with liver elastography or a direct liver fibrosis serum test or, if these tests are unavailable, should be referred to an expert clinician in liver disease. People with MAFLD and a high FIB-4 score (> 2.7), an elevated direct liver fibrosis serum test, high elastography results or with clinical, laboratory or imaging evidence of cirrhosis should be referred for further evaluation. Individuals with a low FIB-4 score (< 1.3), low elastography or direct liver fibrosis serum test results should be monitored with a repeat FIB-4 test at least every three years. Monitoring of weight, body mass index and/or waist circumference and for emergence of type 2 diabetes (in individuals without) should be performed at least annually. CHANGE IN MANAGEMENT AS A RESULT OF THIS CONSENSUS STATEMENT SUMMARY: Appropriate identification, assessment and risk stratification of people with MAFLD will aid referral pathways, further investigation and management.
代谢功能障碍相关脂肪性肝病（MAFLD）很常见。本基于证据的共识声明摘要为基层医疗中成人MAFLD的评估和监测提供建议。
患有2型糖尿病、肥胖症或其他两种或更多代谢风险因素的成年人应接受MAFLD检测。应使用超声评估肝脂肪变性，而2型糖尿病和肥胖症的存在及并发症应根据现行澳大利亚指南进行评估。心血管疾病、慢性肾脏病和阻塞性睡眠呼吸暂停在MAFLD患者中很常见，应作为整体健康评估的一部分加以考虑。必须考虑肝脂肪变性的其他原因，包括过量饮酒，血清氨基转移酶水平升高的患者应检测乙型和丙型肝炎感染及铁过载情况。需要使用纤维化-4（FIB-4）指数评估晚期肝纤维化风险；低评分（<1.3）与晚期肝纤维化超过95%的阴性预测值相关。FIB-4评分不确定（介于1.3和2.7之间）的患者应通过肝脏弹性成像或直接肝纤维化血清检测进行二线评估，或者如果无法进行这些检测，应转诊至肝病专家临床医生处。MAFLD且FIB-4评分高（>2.7）、直接肝纤维化血清检测结果升高、弹性成像结果高或有肝硬化临床、实验室或影像学证据的患者应转诊进行进一步评估。FIB-4评分低（<1.3）、弹性成像或直接肝纤维化血清检测结果低的个体应至少每三年重复进行一次FIB-4检测以进行监测。应至少每年监测体重、体重指数和/或腰围以及2型糖尿病的发生情况（在无2型糖尿病的个体中）。
对MAFLD患者进行适当的识别、评估和风险分层将有助于转诊途径、进一步检查和管理。
