代谢相关脂肪性肝病合并肝硬化治疗的挑战与未来前景

摘要/Abstract

摘要： 代谢相关脂肪性肝病(MAFLD)相关肝硬化已成为慢性肝病的主要病因,与代谢综合征密切相关,如糖尿病、心血管疾病等。该病的治疗面临诸多挑战,包括代谢共病、缺乏特异性药物、门静脉高压、肝衰竭等。生活方式管理、代谢共病优化等虽有一定作用,但疗效有限。由于患者的异质性、合并症的多样性以及纤维化逆转困难等因素,临床药物研发目前同样面临着巨大挑战,仅有少数药物在临床试验中取得初步进展。未来的治疗方向应更侧重于多学科团队合作、精准医疗、数字化管理,为MAFLD相关肝硬化患者带来希望。

关键词: 代谢相关脂肪性肝病, 肝硬化, 管理, 挑战

王昕, 饶慧瑛. 代谢相关脂肪性肝病合并肝硬化治疗的挑战与未来前景[J]. 肝脏, 2025, 30(1): 4-6.

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参考文献

[1] YounossiZM, Wong G, Anstee QM, et al. The Global Burden of Liver Disease[J]. Clin Gastroenterol Hepatol, 2023,21(8):1978-1991.
[2] MiaoL, Targher G, Byrne CD, et al. Current status and future trends of the global burden of MASLD[J]. Trends Endocrinol Metab, 2024,35(8):697-707.
[3] MalletM, Silaghi CA, Sultanik P, et al. Current challenges and future perspectives in treating patients with NAFLD-related cirrhosis[J]. Hepatology,2024,80(5):1270-1290.
[4] HarrisonSA, Bedossa P, Guy CD, et al. A Phase 3, Randomized, Controlled Trial of Resmetirom in NASH with Liver Fibrosis[J]. N Engl J Med, 2024,390(6):497-509.
[5] KeatingSE, Chawla Y, De A, et al. Lifestyle intervention for?metabolic dysfunction-associated fatty liver disease: a 24-h integrated behavior perspective[J]. Hepatol Int, 2024,18(Suppl 2):959-976.
[6] GlassO, Filozof C, Noureddin M, et al. Standardisation of diet and exercise in clinical trials of NAFLD-NASH: Recommendations from the Liver Forum[J]. J Hepatol, 2020,73(3):680-693.
[7] deFranchis R, Bosch J, Garcia-Tsao G, et al. Baveno VII - Renewing consensus in portal hypertension[J]. J Hepatol, 2022,76(4):959-974.
[8] LaiJC, Tandon P, Bernal W, et al. Malnutrition, Frailty, and Sarcopenia in Patients With Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases[J]. Hepatology, 2021,74(3):1611-1644.
[9] AjmeraV, Cepin S, Tesfai K, et al. A prospective study on the prevalence of NAFLD, advanced fibrosis, cirrhosis and hepatocellular carcinoma in people with type 2 diabetes[J]. J Hepatol, 2023,78(3):471-478.
[10] LoombaR, Abdelmalek MF, Armstrong MJ, et al. Semaglutide 2.4 mgonce weekly in patients with non-alcoholic steatohepatitis-related cirrhosis: a randomised, placebo-controlled phase 2 trial[J]. Lancet Gastroenterol Hepatol, 2023,8(6):511-522.
[11] GastaldelliA, Cusi K, Fernández Landó L, et al. Effect of tirzepatide versus insulin degludec on liver fat content and abdominal adipose tissue in people with type 2 diabetes (SURPASS-3 MRI): a substudy of the randomised, open-label, parallel-group, phase 3 SURPASS-3 trial[J]. Lancet Diabetes Endocrinol, 2022,10(6):393-406.
[12] SharptonSR, Loomba R. Emerging role of statin therapy in the prevention and management of cirrhosis, portal hypertension, and HCC[J]. Hepatology, 2023,78(6):1896-1906.
[13] TessierCM, Polyzos SA, Athyros VG, et al. Long-term statin treatment for hepatic fibrosis in patients with nonalcoholic fatty liver disease: Is it time to give the emperor a statin robe[J]? Metabolism, 2021,121:154796.
[14] PaternostroR, Kwanten WJ, Reiberger T. Portal hypertension is a key determinant of the risk for liver-related events in non-alcoholic fatty liver disease[J]. J Hepatol, 2023,78(3):e102-e104.
[15] Garcia-TsaoG, Bosch J, Kayali Z, et al. Randomized placebo-controlled trial of emricasan for non-alcoholic steatohepatitis-related cirrhosis with severe portal hypertension[J]. J Hepatol, 2020,72(5):885-895.
[16] JachsM, Hartl L, Simbrunner B, et al. Prognostic performance of non-invasive tests for portal hypertension is comparable to that of hepatic venous pressure gradient[J]. J Hepatol, 2024,80(5):744-752.
[17] AreVS, Knapp SM, Banerjee A, et al. Improving Outcomes of Bariatric Surgery in Patients With Cirrhosis in the United States: A Nationwide Assessment[J]. Am J Gastroenterol, 2020,115(11):1849-1856.
[18] LassaillyG, Caiazzo R, Ntandja-Wandji LC, et al. Bariatric Surgery Provides Long-term Resolution of Nonalcoholic Steatohepatitis and Regression of Fibrosis[J]. Gastroenterology, 2020,159(4):1290-1301.e5.
[19] RatziuV, Francque S, Sanyal A. Breakthroughs in therapies for NASH and remaining challenges[J]. J Hepatol, 2022,76(6):1263-1278.
[20] FrenetteC, Kayali Z, Mena E, et al. Emricasan to prevent new decompensation in patients with NASH-related decompensated cirrhosis[J]. J Hepatol, 2021,74(2):274-282.
[21] HarrisonSA, Wong VWS, Okanoue T, et al. Selonsertib for patients with bridging fibrosis or compensated cirrhosis due to NASH: Results from randomized phase III STELLAR?trials[J]. J Hepatol, 2020,73(1):26-39.
[22] LoombaR, Noureddin M, Kowdley KV, et al. Combination Therapies Including Cilofexor and Firsocostat for Bridging Fibrosis and Cirrhosis Attributable to NASH[J]. Hepatology, 2021,73(2):625-643.