脂肪变性肝病亚型分类的纵向变化和随后主要不良肝脏结局的风险

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology Pub Date : 2025-09-01 DOI:10.1016/j.aohep.2025.102004

Pedro Raul Ochoa Allemant , Douglas Schaubel , David Kaplan , Marina Serper

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引用次数: 0

摘要

脂肪性肝病（SLD）包括代谢功能障碍相关脂肪性肝病（MASLD）、酒精相关肝病（ALD）及其交叉（MetALD）。SLD亚型分类可能随时间变化；然而，这些转变对主要不良肝脏结局（MALO）的影响尚不清楚。材料和方法我们在退伍军人健康管理局（2010-2021）进行了一项影像学证实的成人脂肪变性（n=270,302）的回顾性研究。主要暴露是队列进入（影像学上的脂肪变性）和2年里程碑之间SLD亚型分类的变化。主要终点是MALO事件（肝硬化、失代偿、HCC、移植、肝脏相关死亡）。我们计算了每100人年的发病率和多变量病因特异性Cox回归模型，以检验SLD亚型变化与随后的MALO之间的关联程度。结果在2年里程碑时，8.2%的基线MASLD重分类为MetALD或ALD， 34.2%的基线MetALD重分类为MASLD或ALD， 64.0%的基线ALD重分类为MASLD或MetALD。在基线MASLD中，重新分类为MetALD （HR 1.55;95% CI 1.40-1.71）或ALD （HR 2.13;95% CI 1.66-2.74）的患者发生MALO的风险高于仍为MASLD的患者。在基线MetALD中，重新分类为MASLD的MALO风险较低（HR 0.55;95% CI 0.48-0.64），而重新分类为ALD的MALO风险较高（HR 1.80;95% CI 1.58-2.06）。在基线ALD中，重新分类为MASLD（风险比0.31;95% CI 0.21-0.46）或MetALD（风险比0.82;95% CI 0.70-0.96）的患者与ALD患者相比，MALO的风险较低。结论SLD亚型分型的改变与不同的MALO风险相关。

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LONGITUDINAL CHANGES IN STEATOTIC LIVER DISEASE SUBTYPE CLASSIFICATION AND SUBSEQUENT RISK OF MAJOR ADVERSE LIVER OUTCOMES

Introduction and Objectives

Steatotic liver disease (SLD) includes metabolic dysfunction-associated steatotic liver disease (MASLD), alcohol-associated liver disease (ALD), and their intersection (MetALD). SLD subtype classification may change over time; however, the impact of these transitions on major adverse liver outcomes (MALO) is unknown.

Materials and Methods

We conducted a retrospective study of adults with imaging-confirmed steatosis (n=270,302) in the Veterans Health Administration (2010-2021). The primary exposure was change in SLD subtype classification between cohort entry (steatosis on imaging) and a 2-year landmark. The primary outcome was incident MALO (cirrhosis, decompensation, HCC, transplant, liver-related death). We calculated incidence rates per 100 person-years and multivariable cause-specific Cox regression models to examine the magnitud of the association between changes in SLD subtype and subsequent MALO.

Results

At the 2-year landmark, 8.2% of those with baseline MASLD were reclassified to MetALD or ALD, 34.2% of those with baseline MetALD were reclassified to MASLD or ALD, and 64.0% of those with baseline ALD were reclassified to MASLD or MetALD. Among baseline MASLD, the risk of MALO was higher for those reclassified to MetALD (HR 1.55;95% CI 1.40-1.71) or ALD (HR 2.13;95% CI 1.66-2.74) compared with those who remained MASLD. Among baseline MetALD, the risk of MALO was lower for those reclassified to MASLD (HR 0.55;95% CI 0.48-0.64) and higher for those reclassified to ALD (HR 1.80;95% CI 1.58-2.06) compared with those who remained MetALD. Among baseline ALD, the risk of MALO was lower for those reclassified to MASLD (HR 0.31;95% CI 0.21-0.46) or MetALD (HR 0.82;95% CI 0.70-0.96) compared with those who remained ALD.

Conclusions

Changes in SLD subtype classification are associated with distinct MALO risks.

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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.