Long-Term Glycemic Control and the Risk of Liver Stiffness Progression and Liver-Related Events in MASLD.

IF 12 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology Pub Date : 2025-10-09 DOI:10.1016/j.cgh.2025.10.003

Xiao-Dong Zhou, Qin-Fen Chen, Seung Up Kim, Terry Cheuk-Fung Yip, Salvatore Petta, Atsushi Nakajima, Emmanuel Tsochatzis, Jérôme Boursier, Elisabetta Bugianesi, Hannes Hagström, Wah-Kheong Chan, Manuel Romero-Gomez, José Luis Calleja, Victor de Lédinghen, Laurent Castéra, Arun J Sanyal, Boon-Bee George Goh, Philip Noel Newsome, Jian-Gao Fan, Michelle Lai, Céline Fournier-Poizat, Hye Won Lee, Grace Lai-Hung Wong, Angelo Armandi, Ying Shang, Grazia Pennisi, Elba Llop, Masato Yoneda, Mirko Zoncapè, Marc de Saint-Loup, Clemence M Canivet, Carmen Lara-Romero, Rocio Gallego-Durán, Paloma Carrillo-Fernández, Amon Asgharpour, Kevin Kim-Jun Teh, Mandy Sau-Wai Chan, Huapeng Lin, Wen-Yue Liu, Giovanni Targher, Christopher D Byrne, Vincent Wai-Sun Wong, Ming-Hua Zheng

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引用次数: 0

Abstract

Background: The long-term impact of type 2 diabetes (T2D) status and long-term glycemic control on disease progression and clinical outcomes in metabolic dysfunction-associated steatotic liver disease (MASLD) remains unclear.

Aims: To assess the association of diabetes status and long-term glycemic control with liver stiffness progression or regression, and liver-related events (LRE) in MASLD.

Methods: We analyzed patients with MASLD from the VCTE-Prognosis cohort who underwent serial vibration-controlled transient elastography (VCTE) assessments and HbA1c measurements. Long-term glycemic control was evaluated using the time-weighted average (TWA) HbA1c, which reflects both the magnitude and duration of glycemia. Patients were categorized as non-T2D, well-controlled T2D (TWA HbA1c<7%), or poorly controlled T2D (TWA HbA1c≥7%). Liver stiffness progression, regression, and LRE were examined using Kaplan-Meier analyses and Cox proportional hazards models.

Results: Of 7,543 patients with MASLD, 4,090 had T2D (2,045 well-controlled, 2,045 poorly controlled), and 3,453 did not have T2D. Over a median follow-up of 4.1 years, patients with T2D had a higher risk of liver stiffness progression (HR=1.501, 95%CI 1.148-1.962, P=0.003) and LRE (HR=2.030, 95%CI 1.241-3.320, P=0.005), but not liver stiffness regression, compared to non-T2D patients. Among patients with T2D, poor glycemic control was associated with a higher risk of liver stiffness progression compared with good glycemic control (HR=1.524, 95%CI 1.182-1.965, P=0.001). No differences were observed for liver stiffness regression (P=0.957) or LRE (P=0.625) with glycemic control. Findings were consistent across sensitivity analyses.

Conclusions: T2D was independently associated with a higher risk of liver stiffness progression and LRE in MASLD. Good glycemic control was associated with slower liver stiffness progression, but not regression or LRE.

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MASLD患者长期血糖控制与肝脏僵硬进展及肝脏相关事件的风险

背景：2型糖尿病（T2D）状态和长期血糖控制对代谢功能障碍相关脂肪变性肝病（MASLD）的疾病进展和临床结局的长期影响尚不清楚。目的：评估糖尿病状态和长期血糖控制与MASLD患者肝脏僵硬进展或消退以及肝脏相关事件（LRE）的关系。方法：我们分析了来自VCTE- prognosis队列的MASLD患者，他们接受了一系列振动控制瞬时弹性成像（VCTE）评估和HbA1c测量。使用时间加权平均（TWA） HbA1c来评估长期血糖控制情况，这反映了血糖的程度和持续时间。结果：7543例MASLD患者中，4090例有T2D（2045例控制良好，2045例控制不良），3453例无T2D。在中位4.1年的随访中，与非T2D患者相比，T2D患者肝脏僵硬进展（HR=1.501, 95%CI 1.148-1.962， P=0.003）和LRE （HR=2.030, 95%CI 1.241-3.320， P=0.005）的风险更高，但肝脏僵硬回归的风险较小。在t2dm患者中，与血糖控制良好的患者相比，血糖控制不良的患者肝脏僵硬进展的风险更高（HR=1.524, 95%CI 1.182-1.965， P=0.001）。肝硬度回归（P=0.957）和LRE （P=0.625）与血糖控制无差异。敏感性分析的结果是一致的。结论：在MASLD中，T2D与肝脏僵硬进展和LRE的高风险独立相关。良好的血糖控制与较慢的肝脏僵硬进展相关，但与退化或LRE无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Gastroenterology and Hepatology 医学-胃肠肝病学

CiteScore

16.90

自引率

4.80%

发文量

903

审稿时长

22 days

期刊介绍： Clinical Gastroenterology and Hepatology (CGH) is dedicated to offering readers a comprehensive exploration of themes in clinical gastroenterology and hepatology. Encompassing diagnostic, endoscopic, interventional, and therapeutic advances, the journal covers areas such as cancer, inflammatory diseases, functional gastrointestinal disorders, nutrition, absorption, and secretion. As a peer-reviewed publication, CGH features original articles and scholarly reviews, ensuring immediate relevance to the practice of gastroenterology and hepatology. Beyond peer-reviewed content, the journal includes invited key reviews and articles on endoscopy/practice-based technology, health-care policy, and practice management. Multimedia elements, including images, video abstracts, and podcasts, enhance the reader's experience. CGH remains actively engaged with its audience through updates and commentary shared via platforms such as Facebook and Twitter.