Liver fibrosis with persistently normal alanine transaminase levels exhibits a distinct treatment response in MASLD.

IF 2.9 Q2 GASTROENTEROLOGY & HEPATOLOGY
Ling Luo, Congxiang Shao, Long Teng, Shuyu Zhuo, Zhi Dong, Wei Wang, Junzhao Ye, Bihui Zhong
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Abstract

Objective: Metabolic dysfunction-associated steatotic liver disease (MASLD) presents considerable variability in disease progression and treatment outcomes. We aimed to determine whether specific patterns of liver inflammatory flares are correlated with distinct treatment responses.

Methods: We conducted an analysis of a well-characterised prospective cohort involving treatment-naïve MASLD patients from January 2015 to November 2023 at The First Affiliated Hospital of Sun Yat-sen University. Participants underwent a standardised 48-week lifestyle modification programme, with follow-up extending through December 2024. Liver fat content (LFC) was assessed using MRI-based proton density fat fraction (MRI-PDFF), whereas liver stiffness measurements (LSMs) were performed using two-dimensional shear wave elastography at baseline and after 48 weeks.

Results: Participants were stratified by alanine transaminase (ALT) and liver fibrosis status: normal ALT/no fibrosis (n=149), elevated ALT/no fibrosis (n=264), normal ALT/fibrosis (n=91) and elevated ALT/fibrosis (n=178). While MRI-PDFF (≥30% LFC decline) and ALT responses (≥17 U/L decrease) did not differ between groups, the elevated ALT/fibrosis group exhibited a significantly higher probability of LSM response (≥1 fibrosis stage improvement) than in the normal ALT/ fibrosis group (53.4% vs 31.9%, p=0.001; OR=2.53, 95% CI: 1.31 to 4.85, p=0.006). Receiver operating characteristic analysis revealed that the cut-offs for weight loss (8.55% vs 4.94%, p=0.023) and LFC reduction (39.85% vs 20.57%, p=0.062) associated with LSM response were higher in patients with normal ALT/fibrosis than in those with elevated ALT/fibrosis.

Conclusion: MASLD patients with liver fibrosis and persistently normal ALT levels exhibited a less favourable treatment response to fibrosis than those with elevated ALT levels, necessitating more substantial reductions in steatosis and weight to achieve the desired outcomes.

丙氨酸转氨酶水平持续正常的肝纤维化在MASLD中表现出明显的治疗反应。
目的:代谢功能障碍相关的脂肪变性肝病(MASLD)在疾病进展和治疗结果方面表现出相当大的变异性。我们的目的是确定特定模式的肝脏炎症是否与不同的治疗反应相关。方法:我们对2015年1月至2023年11月中山大学第一附属医院的treatment-naïve MASLD患者进行了特征明确的前瞻性队列分析。参与者接受了一个标准化的48周生活方式改变计划,随访持续到2024年12月。肝脏脂肪含量(LFC)使用基于mri的质子密度脂肪分数(MRI-PDFF)进行评估,而肝脏硬度测量(lsm)在基线和48周后使用二维剪切波弹性成像进行。结果:参与者按丙氨酸转氨酶(ALT)和肝纤维化状态分层:ALT正常/无纤维化(n=149), ALT升高/无纤维化(n=264), ALT正常/纤维化(n=91)和ALT升高/纤维化(n=178)。虽然MRI-PDFF(≥30% LFC下降)和ALT反应(≥17 U/L下降)在两组之间没有差异,但ALT/纤维化升高组的LSM反应(≥1个纤维化阶段改善)的概率明显高于ALT/纤维化正常组(53.4% vs 31.9%, p=0.001; OR=2.53, 95% CI: 1.31至4.85,p=0.006)。受试者工作特征分析显示,与LSM反应相关的体重减轻(8.55% vs 4.94%, p=0.023)和LFC降低(39.85% vs 20.57%, p=0.062)在ALT/纤维化正常的患者中高于ALT/纤维化升高的患者。结论:与ALT水平升高的患者相比,伴有肝纤维化且ALT水平持续正常的MASLD患者对纤维化的治疗反应较差,需要更大幅度地减少脂肪变性和体重以达到预期的结果。
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来源期刊
BMJ Open Gastroenterology
BMJ Open Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.90
自引率
3.20%
发文量
68
审稿时长
2 weeks
期刊介绍: BMJ Open Gastroenterology is an online-only, peer-reviewed, open access gastroenterology journal, dedicated to publishing high-quality medical research from all disciplines and therapeutic areas of gastroenterology. It is the open access companion journal of Gut and is co-owned by the British Society of Gastroenterology. The journal publishes all research study types, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Publishing procedures are built around continuous publication, publishing research online as soon as the article is ready.
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