拉丁美洲代谢功能障碍相关脂肪变性肝病（masld）患者的肝纤维化：Stella研究的中期结果

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology Pub Date : 2025-09-01 DOI:10.1016/j.aohep.2025.101966

Luis Antonio Díaz Piga , Francisco Idalsoaga , Mario G. Pessoa , Claudia Pinto Marques Souza de Oliveira , Patricia Zitelli , Ezequiel Ridruejo , Mirta Peralta , Cesar Castro , Jorge Garavito-Rentería , Gustavo Ayares , Nancy Solis , María Paz Orellana , Sebastián Marciano , Adrian Gadano , Jorge Martínez Morales , María José Acosta , Martin Tagle , Hugo Cedron , Ismael Yepes Barreto , Dalis Pérez , Marco Arrese

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引用次数: 0

摘要

前言和目的尽管遗传易感性和生活方式行为可能会增加易感性，但关于拉丁美洲MASLD患者肝纤维化风险的前瞻性数据仍然很少。这项跨国前瞻性研究旨在确定拉丁美洲高危人群中纤维化的主要决定因素。材料和方法我们对STELLA研究进行了横断面基线分析，该研究在10个中心（阿根廷15.1%，巴西66.2%，智利5.9%，哥伦比亚1.9%，墨西哥0.3%，秘鲁10.6%）前瞻性纳入MASLD（2023标准）成人。对所有参与者的酒精摄入量、饮食模式和振动控制瞬态弹性成像（VCTE）进行评估。当无法进行活检时，通过肝硬度测量（LSMs）对VCTE截止点进行纤维化分期（晚期≥8.8 kPa，肝硬化≥11.8 kPa）。通过调整年龄、性别、体重指数（BMI）、2型糖尿病（T2DM）、高血压和血脂异常等因素，采用多变量线性回归检查与肝僵硬相关的因素。结果共分析了370名参与者（中位年龄66[58-73]岁，66.7%为女性，中位BMI 30.9 [27.5-34.8] kg/m2）。T2DM患病率为55.8%，高血压患病率为38.3%，血脂异常患病率为39.4%。酒精摄入量中位数为0[0 - 28]克/周。肝硬度中位数为9.2 [6.1-16.6]kPa， 53.2%存在晚期纤维化，18.8%存在肝硬化。在调整后的模型中，女性（β = +3.0 kPa; 95%CI 0.2-5.8; p=0.034）、T2DM （β = +4.9 kPa; 95%CI 2.2-7.6; p<0.001）和血脂异常（β = +3.9 kPa; 95%CI 1.2-6.5; p=0.005）与较高的LSM值独立相关，其中T2DM的影响最大（图）。结论：在这个特征明确的拉美成年MASLD患者队列中，女性、2型糖尿病和血脂异常是肝纤维化的主要危险因素。STELLA项目包括更大的样本和纵向随访，可能进一步阐明拉丁美洲MASLD的自然历史（FONDECYT 1241450）。

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LIVER FIBROSIS IN INDIVIDUALS WITH METABOLIC DYSFUNCTION–ASSOCIATED STEATOTIC LIVER DISEASE (MASLD) IN LATIN AMERICA: INTERIM RESULTS FROM THE STELLA STUDY

Introduction and Objectives

Prospective data on liver-fibrosis risk among Latin Americans with MASLD remain scarce, although genetic susceptibility and lifestyle behaviors may heighten vulnerability. This multinational, prospective study aims to define the principal determinants of fibrosis in this high-risk population across Latin America.

Materials and Methods

We performed a cross-sectional baseline analysis of the STELLA study, which is prospectively enrolling adults with MASLD (2023 criteria) at 10 centers (Argentina 15.1%, Brazil 66.2%, Chile 5.9%, Colombia 1.9%, Mexico 0.3%, Peru 10.6%). Alcohol intake, dietary patterns, and vibration-controlled transient elastography (VCTE) were assessed in all participants. When biopsy was unavailable, fibrosis was staged by liver stiffness measurements (LSMs) on VCTE cut-offs (advanced ≥ 8.8 kPa, cirrhosis ≥ 11.8 kPa). Factors associated with liver stiffness were examined with multivariable linear regression adjusted for age, sex, body mass index (BMI), type 2 diabetes mellitus (T2DM), hypertension, and dyslipidemia.

Results

A total of 370 participants were analyzed (median age 66 [58–73] years; 66.7% women; median BMI 30.9 [27.5–34.8] kg/m²). The prevalence of T2DM was 55.8%, hypertension 38.3%, and dyslipidemia 39.4%. The median alcohol intake was 0 [0–28] grams/week. Median liver stiffness was 9.2 [6.1–16.6] kPa, with advanced fibrosis present in 53.2% and cirrhosis in 18.8%. In the adjusted model, female sex (β = +3.0 kPa; 95%CI 0.2–5.8; p=0.034), T2DM (β = +4.9 kPa; 95%CI 2.2–7.6; p<0.001), and dyslipidemia (β = +3.9 kPa; 95%CI 1.2–6.5; p=0.005) were independently associated with higher LSM values, with T2DM showing the strongest effect (Figure).

Conclusions

In this well-characterized cohort of Latin-American adults with MASLD, female sex, T2DM, and dyslipidemia emerged as leading risk factors for liver fibrosis. The STELLA project, including a larger sample and longitudinal follow-up, may further clarify the natural history of MASLD in Latin America (FONDECYT 1241450).

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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.