代谢相关脂肪性肝病进展期肝纤维化的临床病理特征及预后分析

肝脏 ›› 2025, Vol. 30 ›› Issue (9): 1186-1191.

代谢相关脂肪性肝病进展期肝纤维化的临床病理特征及预后分析

常柳祎, 邵茉莉, 滕国鑫, 马子坤, 李敏, 赵新颜

044000 运城山西医科大学附属运城市中心医院消化内科(常柳祎,邵茉莉);250000 济南山东大学第二医院病理科(滕国鑫);100050 北京首都医科大学附属北京友谊医院肝病中心,国家消化系统疾病临床医学研究中心(马子坤,赵新颜),临床流行病与循证医学研究室(李敏)

收稿日期:2025-02-16 出版日期:2025-09-30 发布日期:2025-11-05
基金资助:
国家自然科学基金项目(no.82103902)

The clinical and pathological features and prognostic analysis of progressive liver fibrosis in metabolic dysfunction associated steatotic liver disease

CHANG Liu-yi¹, SHAO Mo-li¹, TENG Guo-xin², MA Zi-kun³, LI Min⁴, ZHAO Xin-yan³

1. Departmen of Gastroenterology,Yuncheng Central Hospital,Shanxi Medical University,Yuncheng 044000,China;
2. Department of Pathology, The Second Hospital of Shandong University, Jinan 250000, China;
3. Liver Research Center, Beijing Friendship Hospital, Capital Medical University, National Center for Clinical Medicine in Digestive Diseases, Beijing 100050, China;
4. Department of Clinical Epidemiology and Evidence-based Medicine, Beijing Friendship Hospital, Capital Medical University,Beijing 100050, China

Received:2025-02-16 Online:2025-09-30 Published:2025-11-05
Contact: ZHAO Xin-yan, Email: zhao_xinyan @,ccmu.edu.cn

摘要/Abstract

摘要： 目的对比代谢相关脂肪性肝病(MASLD)进展期肝纤维化(F3)与肝硬化(F4)的临床、病理特征及临床结局的异同。方法纳入2013年5月至2023年12月北京友谊医院肝组织活检明确诊断为MASLD进展期肝纤维化患者65例,其中,F3期28例,F4期37例。对比两组临床、病理特征及临床结局的差异。采用Cox回归模型分析进展期肝纤维化出现肝硬化失代偿期的影响因素。结果两组患者的性别、年龄、体质指数以及合并症差异无统计学意义(均P>0.05)。与F3期相比,F4期患者的凝血酶原活动度、铁蛋白均较低,分别为81.30%比93.45%、135.60 ng/mL比261.45 ng/mL,国际标准化比值、肝硬度值均较高,为1.11比1.06、20.80 kPa比16.30 kPa,差异均有统计学意义(P<0.05)。两组脂变范围及气球样变程度的差异无统计学意义(均P>0.05),与F3期相比,F4期的脂变分布更加没有规律、小叶内炎症程度显著减少,而汇管区炎症、界面炎及细胆管反应显著增加(均P<0.05)。两组发生肝硬化失代偿期、肝癌、死亡/移植的差异均无统计学意义(均P>0.05)。多因素Cox回归分析结果显示,年龄及空腹血糖是进展期肝纤维化患者出现肝硬化失代偿期事件的独立危险因素(HR=0.859,95%CI:0.754~0.977,P<0.05; HR=1.343,95%CI:1.004~1.796,P<0.05)。结论 MASLD进展期肝纤维化F3期与F4期的临床特征及病理特征存在一定差异,但临床结局无明显差异。

Abstract: Objective To comparatively study on the similarities and differences in clinical, pathological characteristics, and clinical outcomes between advanced liver fibrosis (F3) and cirrhosis (F4) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). Methods A retrospective analysis was conducted on 65 patients with MASLD diagnosed with advanced liver fibrosis via liver biopsy. The patients were divided into two groups: F3 and F4. The clinical, pathological characteristics, and clinical outcomes of the two groups of patients were compared. Cox regression models were used to analyze the factors influencing the progression of patients with advanced liver fibrosis to decompensated cirrhosis. Results Among the 65 patients analyzed, 28 were in the F3 stage and 37 were in the F4 stage. There were no statistically significant differences between the two groups in terms of gender, age, body mass index (BMI), or comorbidities (P>0.05). Laboratory tests showed that, compared to the F3 group, the F4 group had lower prothrombin activity and ferritin levels (81.30% vs 93.45%, P<0.05; 135.60 ng/mL vs 261.45 ng/mL, P<0.05), and higher international normalized ratio and liver stiffness measurement values (1.11 vs 1.06, P<0.05; 20.80 kPa vs 16.30 kPa, P<0.05). In terms of pathological features, there were no significant differences in the extent of steatosis or ballooning degeneration between the two groups (P>0.05). However, compared to the F3 group, the F4 group exhibited more irregular distribution of steatosis, significantly reduced lobular inflammation, significantly increased portal inflammation and interface hepatitis, as well as ductular reaction (P<0.05). Regarding clinical outcomes, there were no significant differences between the two groups in the occurrence of decompensated cirrhosis, hepatocellular carcinoma, or death/transplantation (P>0.05). Univariate Cox regression analysis of factors influencing the progression of patients with advanced liver fibrosis to decompensated cirrhosis identified that age, BMI, fasting blood glucose, gamma-glutamyl transferase, and controlled attenuation parameter (CAP) were the significant factors. Multivariate Cox regression analysis revealed that age and fasting blood glucose were independent risk factors for the progression of patients with advanced liver fibrosis to decompensated cirrhosis (HR=0.859, 95%CI:0.754~0.977, P<0.05; HR=1.343, 95%CI:1.004~1.796, P<0.05). Conclusion There are certain differences in clinical and pathological characteristics between F3 and F4 stages of advanced liver fibrosis in MASLD patients, but there is no significant difference in clinical outcomes.

Key words: Metabolic dysfunction-associated steatotic liver disease, Advanced liver fibrosis, Clinical features, Pathological features, Clinical prognosis, Risk factors

常柳祎, 邵茉莉, 滕国鑫, 马子坤, 李敏, 赵新颜. 代谢相关脂肪性肝病进展期肝纤维化的临床病理特征及预后分析[J]. 肝脏, 2025, 30(9): 1186-1191.

CHANG Liu-yi, SHAO Mo-li, TENG Guo-xin, MA Zi-kun, LI Min, ZHAO Xin-yan. The clinical and pathological features and prognostic analysis of progressive liver fibrosis in metabolic dysfunction associated steatotic liver disease[J]. Chinese Hepatolgy, 2025, 30(9): 1186-1191.

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