EASL-EASD算法用于代谢功能障碍相关脂肪变性肝病和2型糖尿病患者风险分层的前瞻性验证

IF 4 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Clara Amiama Roig, Miriam Romero, Noemí González, Laura Guerra Pastrián, Elena Palacios Lázaro, Pilar Castillo Grau, Marta Abadía Barno, Araceli García Sánchez, Alexa Pamela Benítez, Mariana Serres, Carmen Amor, Irene González Díaz, Antonio Buño, Antonio Olveira, María Patricia Sanz
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引用次数: 0

摘要

背景和目的:2型糖尿病患者发生严重代谢功能障碍相关脂肪变性肝病(MASLD)的风险增加。欧洲糖尿病研究协会(EASD)最近提出了一种风险分层和转诊的两步算法,该算法是与欧洲肝脏研究协会(EASL)合作开发的,但其实际表现仍未得到评估。方法:在前瞻性研究中,使用FIB-4指数对在我院糖尿病门诊就诊的成年2型糖尿病患者进行连续评估。FIB-4≥1.3的患者接受肝脏病学的进一步评估,包括瞬时弹性成像(TE)、腹部超声、ELF评分、排除其他肝脏疾病,并在必要时进行肝活检。排除已知有肝脏疾病或1型糖尿病的患者。高危人群定义为TE≥8kPa或FIB-4>2.67。晚期肝病定义为活检纤维化分期≥F3, TE>12kPa,或超声显示肝硬化。以当代人群为基础的超过12000人的队列作为MASLD严重程度的参考。结果:2024年第4季度至2025年第一季度,筛查了1108例患者;984人仍然符合资格。其中736例(74.8%)的FIB-42.67(66)。在后者中,53例(21.4%;95% CI: 16.7-26.9)曾有未确诊的晚期MASLD,患病率超过参考人群。另外15例患者(6%)患有其他显著的肝脏疾病:自身免疫性肝炎、原发性胆管炎、病毒性肝炎……总体而言,该算法识别出任何病因的晚期肝病的比例为27.4%。结论:FIB-4≥1.3的患者中约有1 / 5为晚期MASLD。EASL-EASD算法支持早期发现和转诊。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prospective validation of the EASL-EASD algorithm for risk stratification in patients with metabolic dysfunction-associated steatotic liver disease and type 2 diabetes.

Background and aim: Individuals with type2 diabetes are at increased risk of severe metabolic dysfunction-associated steatotic liver disease(MASLD). The European Association for the Study of Diabetes(EASD) recently proposed a two-step algorithm for risk stratification and referral, developed in collaboration with the European Association for the Study of the Liver(EASL), but its real-world performance remains unassessed.

Methods: In prospective study, adult patients with type2 diabetes attending our Diabetology clinic were consecutively assessed using FIB-4 index. Those with FIB-4≥1.3 underwent further evaluation in collaboration with Hepatology, including transient elastography(TE), abdominal ultrasound, ELF score, exclusion of other liver diseases, and liver biopsy when indicated. Patients with known liver disease or type 1 diabetes were excluded. At-risk individuals were defined as those with TE≥8kPa or FIB-4>2.67. Advanced liver disease was defined as fibrosis stage ≥F3 on biopsy, TE>12kPa, or ultrasound evidence of cirrhosis. A contemporary population-based cohort of over 12000 individuals served as a reference for MASLD severity.

Results: Between Q4 2024 and Q1 2025, 1108 patients were screened; 984 remained eligible. Of these, 736(74.8%) had FIB-4<1.3 and 248(25.2%;95% CI:22.5-27.9) had elevated FIB-4(1.3-2.67 in 182;>2.67 in 66). Among the latter, 53(21.4%;95% CI: 16.7-26.9) had previously undiagnosed advanced MASLD, with prevalence exceeding that in the reference population. An additional 15patients(6%) had other significant liver diseases: autoimmune hepatitis, primary biliary cholangitis, viral hepatitis...Overall, the algorithm identified advanced liver disease of any aetiology in 27.4%.

Conclusions: About one in five patients with FIB-4≥1.3 had advanced MASLD. The EASL-EASD algorithm supports early detection and referral.

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来源期刊
CiteScore
2.00
自引率
25.00%
发文量
400
审稿时长
6-12 weeks
期刊介绍: La Revista Española de Enfermedades Digestivas, Órgano Oficial de la Sociedad Española de Patología Digestiva (SEPD), Sociedad Española de Endoscopia Digestiva (SEED) y Asociación Española de Ecografía Digestiva (AEED), publica artículos originales, editoriales, revisiones, casos clínicos, cartas al director, imágenes en patología digestiva, y otros artículos especiales sobre todos los aspectos relativos a las enfermedades digestivas.
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