代谢相关脂肪性肝病的无创诊断与药物治疗

Noninvasive diagnosis and pharmacotherapy of metabolic dysfunctionassociated steatotic liver disease

代谢相关脂肪性肝病(MASLD)是全球最常见的慢性肝病,从单纯性脂肪变性进展到有损伤和炎症的代谢性脂肪性肝炎(MASH),有或没有纤维化,最后都可进展为肝硬化和肝细胞癌,影响了世界上约25%人的健康。肝活检是鉴别MASH与脂肪变性、评估晚期纤维化的金标准,但其昂贵性、侵入性和取样偏倚等缺点推动了无创诊断技术的发展。此外,目前美国FDA尚无批准的用于治疗MASLD的药物。该综述主要列举了有潜力替代肝活检的无创诊断标记物,讨论了目前MASLD的治疗选择,临床试验设计旨在评估单一药物或联合疗法阻止或逆转疾病进展的疗效和安全性,期望能为MASLD的临床诊断和药物治疗提供新的思路。

Metabolic dysfunction-associated steatotic liver disease(MASLD)is the most prevalent chronic liver disease globally,encompassing the entire spectrum of fatty liver pathogenesis.It progresses from simple steatosis to metabolic-associated steatohepatitis(MASH),involving injury and inflammation,with or without fibrosis,ultimately leading to cirrhosis and hepatocellular carcinoma,which affects approximately a quarter of the world's population.Liver biopsy remains the gold standard for differentiating MASH from steatosis and assessing advanced fibrosis.However,its limitations,including costliness,invasiveness,and sampling bias,have spurred the development of noninvasive diagnostic techniques.In addition,there are no FDAapproved drugs for the treatment of MASLD.Enumerating noninvasive diagnostic markers that have the potential to replace liver biopsy were summarized,and the current treatment options for MASLD were discussed,with clinical trials designed to evaluate the efficacy and safety of single agents or combination therapies to halt or reverse disease progression,which could provide new insights for the clinical diagnosis and treatment of MASLD.