非酒精性脂肪性肝病更名前后的人群分布变化及代谢功能障碍相关脂肪性肝病肝纤维化的危险因素分析

Population distribution of non-alcoholic fatty liver disease before and after renaming and risk factors for liver fibrosis in metabolic dysfunction-associated steatotic liver disease

目的探讨非酒精性脂肪性肝病(NAFLD)更名前后的人群分布以及代谢功能障碍相关脂肪性肝病(MASLD)代谢危险因素(MRF)种类与晚期肝纤维化的相关性。方法选取2019年1月—2022年1月徐州医科大学附属医院和无锡市第五人民医院收治的经肝穿刺活检肝细胞发生脂肪变性≥5%的515例脂肪变性肝病(SLD)患者。513例(有2例分别不符合NAFLD和MAFLD诊断,被归为其他特定原因的SLD,不参与分组)SLD患者分为3组:MASLD组(n=275)、合并组(MASLD合并其他肝病,n=216)和隐源性SLD组(n=22)。比较不同组SLD患者临床特征、实验室指标、晚期肝纤维化的差异。其次比较合并不同种类MRF的MASLD的临床特征、实验室指标、晚期肝纤维化的差异,分析MASLD患者合并晚期肝纤维化的危险因素。偏态分布的计量资料多组间比较及进一步两两比较均采用Kruskal-Wallis H检验。计数资料多组间比较采用χ^(2)检验,进一步两两比较采用Bonferroni校正。影响肝纤维化发生的危险因素采用Logistic回归分析。结果在515例SLD患者中,NAFLD 297例(57.7%)(22例隐源性SLD,275例MASLD),MAFLD 467例(90.7%)(216例被诊断为和其他病因共存的MASLD)。3组间性别、BMI、GGT、TG、CHOL、LDL-C、HDL-C、FPG、NFS、FIB-4比较差异均有统计学意义(P值均<0.05)。与MASLD组、隐源性SLD组相比,合并组患者晚期肝纤维化(F3~4)占比最高(P<0.001)。随着MRF种类的增加,患者年龄更大,更有可能是女性,更可能合并高血压、糖尿病,并具有更高的代谢相关参数水平,包括BMI、血脂和血糖水平(P值均<0.05)。MASLD患者随MRF种类的增加,无创纤维化评分(NFS、FIB-4)更高,合并晚期纤维化(F3~4)比例更高(P<0.05)。多因素Logistic回归分析结果显示,年龄≥50岁(OR=2.622,95%CI:1.091~6.300,P=0.031)和MRF种类增加(OR=1.876,95%CI:1.194~2.947,P=0.006)均为MASLD伴严重肝纤维化的独立危险因素。结论新的MASLD定义基于MRF的阳性识别,重新分类的人群少于MAFLD定义的人群,与NAFLD定义的人群差异较小。此外,年龄≥50岁以及MRF种类的增加均为MASLD合并晚期肝纤维化的独立危险因素。

Objective To investigate the population distribution of non-alcoholic fatty liver disease before and after renaming and the association between the types of metabolic risk factors(MRF)for metabolic dysfunction-associated steatotic liver disease(MASLD)and advanced liver fibrosis.Methods This study was conducted among 515 patients who were admitted to The Affiliated Hospital of Xuzhou Medical University and Wuxi Fifth People’s Hospital from January 2019 to January 2022 and had hepatocyte steatosis≥5%by liver biopsy.Among these patients,2 patients did not meet the diagnostic criteria for nonalcoholic fatty liver disease(NAFLD)and metabolic associated fatty liver disease(MAFLD),respectively,and were classified as steatotic liver disease(SLD)with other specific causes,and the other 513 patients were divided into MASLD group with 275 patients,comorbid group with 216 patients(MASLD comorbid with other liver diseases),and cryptogenic SLD group with 22 patients.The above groups were compared in terms of clinical features,laboratory markers,and advanced liver fibrosis.The MASLD patients with different types of MRF were compared in terms of clinical features,laboratory markers,and advanced liver fibrosis,and the risk factors for advanced liver fibrosis in patients with MASLD were analyzed.The Kruskal-Wallis H test was used for comparison of continuous data with skewed distribution between multiple groups and further comparison between two groups;the chi-square test was used for comparison of categorical data between multiple groups,and Bonferroni correction was used for further comparison between two groups.The logistic regression analysis was used to identify the risk factors for liver fibrosis.Results Among the 515 patients with SLD,297 patients(57.7%)met the diagnostic criteria for NAFLD,among whom 22 were classified as cryptogenic SLD and 275 met the diagnostic criteria for MASLD,and 467(90.7%)were diagnosed with MAFLD.There were significant differences between the three groups in sex,body mass index(BMI),gamma-glutamyl transpeptidase,triglyceride,cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,fasting plasma glucose,NAFLD fibrosis score(NFS),fibrosis-4(FIB-4),and F3-4(all P<0.05).Compared with the MASLD group and the cryptogenic SLD group,the comorbid group had the highest proportion of patients with advanced liver fibrosis(P<0.001).With the increase in the type of MRF,the patients tended to have an older age,a significantly higher proportion of female patients,a higher possibility of hypertension and diabetes,and higher levels of metabolic parameters including BMI,blood lipids,and blood glucose(all P<0.05).With the increase in the types of MRF in MASLD patients,they tended to have significantly higher noninvasive fibrosis scores(NFS and FIB-4)and a significantly higher proportion of patients with advanced liver fibrosis(P<0.05).The multivariate logistic regression analysis showed that age≥50 years(odds ratio[OR]=2.622,95%confidence interval[CI]:1.091—6.300,P=0.031)and the increase in the type of MRF(OR=1.876,95%CI:1.194—2.947,P=0.006)were independent risk factors for MASLD with severe liver fibrosis.Conclusion The new definition of MASLD is based on the positive identification of MRF,and the reclassified population of MASLD is smaller than that of MAFLD,with little difference from that of NAFLD.In addition,age≥50 years and the increase in the type of MRF are independent risk factors for MASLD with advanced liver fibrosis.