Combined effect of histological findings and diabetes mellitus on liver-related events in patients with metabolic dysfunction-associated steatotic liver disease

IF 3.9 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Hepatology Research Pub Date : 2024-04-24 DOI:10.1111/hepr.14049
Akihito Shiomi, Teruki Miyake, Shinya Furukawa, Bunzo Matsuura, Osamu Yoshida, Takao Watanabe, Ayumi Kanamoto, Masumi Miyazaki, Hironobu Nakaguchi, Yoshio Tokumoto, Masashi Hirooka, Masanori Abe, Yoichi Hiasa
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Abstract

Aim

Advanced fibrosis has a strong influence on the occurrence of liver-related events in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), while diabetes mellitus (DM), which is often complicated by MASLD, is associated with the progression of MASLD. We stratified patients with MASLD according to the severity of liver pathological findings and the presence of DM, aiming to examine whether these indices could be used to accurately assess the risk of developing liver-related events.

Methods

A total of 282 patients with liver biopsy-proven MASLD were included. Liver-related events were defined as the occurrence of hepatocellular carcinoma (HCC) and complications of liver cirrhosis, such as ascites, hepatic encephalopathy, Child–Pugh class B and C, as well as treatment-eligible esophageal and gastric varices.

Results

Multivariate analysis adjusted for age, sex, body mass index, alanine aminotransferase, creatinine, hemoglobin A1c, smoking habits, dyslipidemia, hypertension, nonalcoholic fatty liver disease activity score (NAS), or fibrosis stage showed that advanced fibrosis with or without DM was a risk factor for liver-related events. The combined effect of DM and advanced fibrosis increased the risk of HCC onset. However, DM alone or in combination with NAS did not affect the development of liver-related events, including the occurrence of HCC and complications of liver cirrhosis.

Conclusions

While the assessment of fibrosis in patients with MASLD is important for evaluating the risk of developing liver-related events, combining the assessment of DM may be possible to stratify groups at higher risk of developing HCC.

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组织学检查结果和糖尿病对代谢功能障碍相关性脂肪肝患者肝脏相关事件的综合影响
目的 晚期肝纤维化对代谢功能障碍相关性脂肪性肝病(MASLD)患者发生肝脏相关事件有很大影响,而糖尿病(DM)往往并发于MASLD,与MASLD的进展相关。我们根据肝脏病理检查结果的严重程度和是否存在糖尿病对MASLD患者进行了分层,旨在研究这些指标是否可用于准确评估发生肝脏相关事件的风险。肝脏相关事件的定义是发生肝细胞癌(HCC)和肝硬化并发症,如腹水、肝性脑病、Child-Pugh B级和C级,以及符合治疗条件的食管和胃静脉曲张。结果经调整年龄、性别、体重指数、丙氨酸氨基转移酶、肌酐、血红蛋白A1c、吸烟习惯、血脂异常、高血压、非酒精性脂肪肝活动评分(NAS)或肝纤维化分期后进行的多变量分析表明,伴有或不伴有DM的晚期肝纤维化是肝脏相关事件的风险因素。糖尿病和晚期肝纤维化的共同作用增加了发生 HCC 的风险。结论尽管评估MASLD患者的纤维化程度对于评估肝脏相关事件的发生风险非常重要,但结合DM评估可能会对发生HCC风险较高的人群进行分层。
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来源期刊
Hepatology Research
Hepatology Research 医学-胃肠肝病学
CiteScore
8.30
自引率
14.30%
发文量
124
审稿时长
1 months
期刊介绍: Hepatology Research (formerly International Hepatology Communications) is the official journal of the Japan Society of Hepatology, and publishes original articles, reviews and short comunications dealing with hepatology. Reviews or mini-reviews are especially welcomed from those areas within hepatology undergoing rapid changes. Short communications should contain concise definitive information.
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