Sheptulina Anna F, Yafarova Adel A, Mamutova Elvira M, Drapkina Oxana M
Laboratory of Experimental and Preventive Gastroenterology, National Medical Research Center for Therapy and Preventive Medicine, Moscow 101990, Russia.
Department of Fundamental and Applied Aspects of Obesity, National Medical Research Center for Therapy and Preventive Medicine, Moscow 101990, Russia.
Healthcare (Basel). 2025 Sep 3;13(17):2206. doi: 10.3390/healthcare13172206.
BACKGROUND/OBJECTIVES: Fatigue is the most common systemic manifestation of chronic liver diseases, including metabolic dysfunction-associated steatotic liver disease (MASLD). Fatigue not only adversely affects quality of life in MASLD patients but also complicates the attainment of therapeutic goals and contributes to a worse prognosis. This study aimed to analyze the relationship between clinically significant fatigue and laboratory parameters reflecting systemic inflammation, liver function, body composition, muscle strength, and blood pressure in patients with MASLD.
A total of 154 patients with a confirmed diagnosis of MASLD were enrolled in this study. All participants underwent anthropometric assessment, laboratory testing, abdominal ultrasonography, and point shear-wave elastography. Muscle strength was evaluated using handgrip strength (GS) measurement and the Five Times Sit-to-Stand Test (5TSTS). Skeletal muscle mass (SMM) was quantified using dual-energy X-ray absorptiometry (DXA). Fatigue was evaluated using the Fatigue Assessment Scale (FAS), with scores ≥ 22 indicating clinically significant fatigue.
Patients with FAS scores ≥ 22 exhibited significantly lower hemoglobin levels ( = 0.004) and erythrocyte counts ( = 0.011), along with a significantly elevated erythrocyte sedimentation rate (ESR; = 0.002) and C-reactive protein level (CRP; = 0.007). Furthermore, MASLD patients with FAS scores ≥ 22 demonstrated significantly reduced relative grip strength ( = 0.012) and took longer to complete the 5TSTS ( = 0.011). Additionally, these patients had higher maximum systolic and diastolic blood pressure values compared to those with FAS scores < 22 ( = 0.028 and = 0.019, respectively).
These findings underscore the multifactorial nature of fatigue in MASLD and highlight the need for a comprehensive management strategy. Such a strategy should include dietary modification, increased physical activity, targeted treatment of systemic manifestations of MASLD, and appropriate management of comorbidities.
背景/目的：疲劳是慢性肝病最常见的全身表现，包括代谢功能障碍相关脂肪性肝病（MASLD）。疲劳不仅对MASLD患者的生活质量产生不利影响，还会使治疗目标的实现复杂化，并导致更差的预后。本研究旨在分析MASLD患者中具有临床意义的疲劳与反映全身炎症、肝功能、身体成分、肌肉力量和血压的实验室参数之间的关系。
本研究共纳入154例确诊为MASLD的患者。所有参与者均接受人体测量评估、实验室检查、腹部超声检查和点剪切波弹性成像检查。使用握力（GS）测量和五次坐立试验（5TSTS）评估肌肉力量。使用双能X线吸收法（DXA）对骨骼肌质量（SMM）进行量化。使用疲劳评估量表（FAS）评估疲劳，得分≥22表明存在具有临床意义的疲劳。
FAS评分≥22的患者血红蛋白水平（P = 0.004）和红细胞计数（P = 0.011）显著降低，同时红细胞沉降率（ESR；P = 0.002）和C反应蛋白水平（CRP；P = 0.007）显著升高。此外，FAS评分≥22的MASLD患者相对握力显著降低（P = 0.012），完成5TSTS的时间更长（P = 0.011）。此外，与FAS评分<22的患者相比，这些患者的收缩压和舒张压最高值更高（分别为P = 0.028和P = 0.019）。
这些发现强调了MASLD中疲劳的多因素性质，并突出了综合管理策略的必要性。这样的策略应包括饮食调整、增加体育活动、针对性治疗MASLD的全身表现以及适当管理合并症。
