肥胖患者肾损伤和代谢功能障碍相关的脂肪变性肝病

Q2 Medicine
Arquivos de Gastroenterologia Pub Date : 2025-05-02 eCollection Date: 2025-01-01 DOI:10.1590/S0004-2803.24612025-008
Kellyane Dias Carvalho, Cláudia Daltro, Carla Daltro, Helma Pinchemel Cotrim
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引用次数: 0

摘要

背景:代谢功能障碍相关脂肪变性肝病(MASLD)是目前世界范围内最常见的慢性肝病病因。最近,MASLD与肾损伤之间的关联已成为影响MASLD临床病程的另一个因素。目的:评价肥胖患者的临床相关性。方法:本研究招募了来自肥胖外科治疗中心的II级和III级肥胖(BMI≥35 kg/m2)和MASLD患者。MASLD的诊断标准包括肝脂肪变性的存在,通过组织学或影像学评估。我们使用纤维化-4 (FIB-4)和NAFLD纤维化评分(NSF)来评估和确定肝纤维化的存在。肾小球滤过率(GRF)采用CKD-EPI(慢性肾脏疾病流行病学协作)方程测定,GFR水平≥90。结果:该研究共纳入560例II级和III级肥胖患者,325例MASLD患者。其中女性422例(75.4%),平均年龄36±10岁。162例(41.1%)患者存在系统性动脉高血压(SAH), 218例(42.8%)患者被诊断为2型糖尿病(T2DM)。共有286人(51.1%)GFR低于114 mL/min,其中183人(64%)表现出较高程度的肝纤维化,如FIB-4 >0.54所示。结论:在II级和III级肥胖患者中,年龄是导致GFR下降的主要决定因素。此外,肾小球高滤过可能是慢性肾脏疾病进展的早期征兆。尽管如此,肝纤维化的进展也可能是导致肾功能受损的重要因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
RENAL INJURY AND METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE IN PATIENTS WITH OBESITY.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is currently the most prevalent cause of chronic hepatic disease worldwide. Recently, the association between MASLD and renal injury has emerged as an additional factor impacting the clinical course of MASLD.

Objective: The present study evaluated the clinical association in patients with obesity.

Methods: This study enrolled patients classified as having obesity class II and III (BMI >35 kg/m2) and MASLD from an obesity surgical treatment center. The diagnosis criteria for MASLD included the presence of hepatic steatosis as indicated by histology or imaging assessments. We use Fibrosis-4 (FIB-4) and NAFLD fibrosis score (NSF) to assess and determine the presence of liver fibrosis. The glomerular filtration rate (GRF) was determined using CKD-EPI (chronic kidney disease epidemiology collaboration) equation, with GFR levels ≥90 and <120 mL/min/1,73 m2 considered within the normal range.

Results: The study comprised a total of 560 individuals with obesity grade II and III, 325 individuals with MASLD. Among these, 422 (75.4%) patients were female, and the mean age was 36±10 years. Systemic arterial hypertension (SAH) was present in 162 (41.1%) patients, and 218 (42.8 %) were diagnosed with type 2 Diabetes Mellitus (T2DM). A total of 286 individuals (51.1%) had a GFR below 114 mL/min, with 183 (64%) of them exhibiting a higher degree of liver fibrosis, as indicated by FIB-4 >0.54.

Conclusion: In patients with obesity classified as grades II and III, age emerged as the primary determinant leading to decline in GFR. Furthermore, glomerular hyperfiltration could be an early sign of progression to chronic kidney disease. Nonetheless, the progression of hepatic fibrosis could also be a significant factor contributing to impaired renal function.

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来源期刊
Arquivos de Gastroenterologia
Arquivos de Gastroenterologia Medicine-Gastroenterology
CiteScore
2.00
自引率
0.00%
发文量
109
审稿时长
9 weeks
期刊介绍: The journal Arquivos de Gastroenterologia (Archives of Gastroenterology), a quarterly journal, is the Official Publication of the Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia IBEPEGE (Brazilian Institute for Studies and Research in Gastroenterology), Colégio Brasileiro de Cirurgia Digestiva - CBCD (Brazilian College of Digestive Surgery) and of the Sociedade Brasileira de Motilidade Digestiva - SBMD (Brazilian Digestive Motility Society). It is dedicated to the publishing of scientific papers by national and foreign researchers who are in agreement with the aim of the journal as well as with its editorial policies.
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