探索代谢功能障碍在酒精相关性肝炎中的作用：一项全球研究

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology Pub Date : 2025-09-01 DOI:10.1016/j.aohep.2025.101970

María Ignacia Pérez Garayar , Vania Cari Gormaz , Ignacio Téllez , Francisco Idalsoaga , Gene Im , Bastian Alcayaga , Muzzafar Haque , Stephanie Rutledge , Hanna Blaney , Pojsakorn Danpanichkul , Arun Valsan , Gowripriya Nair , Gustavo Ayares , Renata Farías , Jorge Arnold , Pedro Acuña , Kaanthi Rama , Carlos Esteban Coronel-Castillo , María Ayala-Valverde , Carolina Ramirez-Cadiz , Juan Pablo Arab

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引用次数: 0

摘要

重度酒精相关性肝炎（AH）死亡率高。尽管心脏代谢危险因素（CMRF）——包括肥胖、2型糖尿病（T2DM）、高血压（HTN）和血脂异常（DLP）——在脂肪变性肝病中的作用已被证实，但它们在AH严重程度中的作用仍不清楚。评价CMRF对AH患者死亡率和感染风险的影响。材料和方法一项跨国前瞻性队列研究（2015-2024），包括14个国家24个中心的严重AH住院患者（Global AlcHep Network）。AH的诊断采用NIAAA标准。分析包括以肝移植为竞争风险的竞争风险模型。模型根据年龄、性别、种族、肝硬化史、CMRF、皮质类固醇使用、MELD和ACLF分级进行调整。结果共纳入935名受试者。中位BMI为24.2kg/m2， T2DM患病率为21%，HTN为17%，DLP为7%。在调整后的竞争风险模型中，年龄（sHR 1.02, 95%CI: 1.01-1.04; p<0.001）、MELD （sHR 1.04, 95%CI: 1.01-1.06; p<0.001）、感染（sHR 1.76, 95%CI: 1.28-2.41; p<0.001）和ACLF 2级（sHR 1.67, 95%CI: 1.05-2.69; p<0.032）和3级（sHR 3.06, 95%CI: 1.88-4.99; p<0.001）与较高的死亡率相关，而肥胖（sHR 0.67, 95%CI: 0.48-0.93; p=0.016）和皮质类固醇使用（sHR 0.67, 95%CI: 0.49-0.92; p=0.014）与较低的死亡率相关。T2DM、HTN和DLP与较高的死亡率无关。结论：代谢功能障碍与AH患者死亡率增加无关。虽然肥胖可能是一个保护因素，但这些发现可以用比瘦人更好的营养状况来解释。

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EXPLORING THE ROLE OF METABOLIC DYSFUNCTION IN ALCOHOL-ASSOCIATED HEPATITIS: A GLOBAL STUDY

Introduction and Objectives

Severe alcohol-associated hepatitis (AH) carries high mortality. Although the role of cardiometabolic risk factors (CMRF)—including obesity, type 2 diabetes mellitus (T2DM), hypertension (HTN), and dyslipidemia (DLP)—has been characterized in steatotic liver disease, their role in the severity of AH remains unclear.

To evaluate the impact of CMRF on mortality and infection risk in AH.

Materials and Methods

Multinational prospective cohort study (2015–2024) including hospitalized patients with severe AH across 24 centers in 14 countries (Global AlcHep Network). Diagnosis of AH was done using NIAAA criteria. Analyses included competing-risk models, with liver transplantation as a competing risk. Models were adjusted by age, sex, ethnicity, history of cirrhosis, CMRF, corticosteroids use, MELD, and ACLF grade.

Results

935 participants were included. Median BMI was 24.2kg/m2, prevalence of T2DM was 21%, HTN 17%, DLP 7%. In adjusted competing-risk models, age (sHR 1.02, 95%CI: 1.01-1.04; p<0.001), MELD (sHR 1.04, 95%CI: 1.01–1.06; p<0.001), infections (sHR 1.76, 95%CI: 1.28–2.41; p<0.001), and ACLF grade 2 (sHR 1.67, 95%CI: 1.05–2.69; p<0.032) and 3 (sHR 3.06, 95%CI: 1.88–4.99; p<0.001) were associated with higher risk of mortality, while obesity (sHR 0.67, 95%CI: 0.48–0.93; p=0.016) and corticosteroids use (sHR 0.67, 95%CI: 0.49–0.92; p=0.014) were associated with lower mortality. T2DM, HTN and DLP weren’t associated with higher mortality.

Conclusions

Metabolic dysfunction was not associated with increased mortality in AH. Although obesity may be a protective factor, these findings could be explained by a better nutritional status than the lean population.

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来源期刊

Annals of hepatology 医学-胃肠肝病学

CiteScore

7.90

自引率

2.60%

发文量

183

审稿时长

4-8 weeks

期刊介绍： Annals of Hepatology publishes original research on the biology and diseases of the liver in both humans and experimental models. Contributions may be submitted as regular articles. The journal also publishes concise reviews of both basic and clinical topics.