代谢功能障碍相关脂肪性肝病及其进展病变的诊疗现状与展望

摘要/Abstract

摘要： 代谢功能障碍相关脂肪性肝病(MASLD)及代谢相关脂肪性肝炎累及全球约1/3的人群,已成为全球重大公共卫生问题,中国成人的患病率也持续攀升。然而,MASLD多呈非进展性和可逆性,是全身代谢失调的肝脏局部表现,不应等同于活动性肝病,也不宜视为传统意义上的独立疾病。临床相关肝病通常发生在脂肪变性进展至代谢相关脂肪性肝炎的过程中,尤其是伴有肝纤维化时,这提示应在疾病监测和治疗中实施精准风险分层,并开展多学科协作诊治,在提高疾病检出率的同时避免医疗体系产生资源浪费。在公共卫生层面,需提高患者对疾病的认知水平,相关政策应推动建设多学科协作机制,将MASLD管理纳入慢性病防控体系,强化基层筛查能力。

宋林楠, 饶慧瑛. 代谢功能障碍相关脂肪性肝病及其进展病变的诊疗现状与展望[J]. 肝脏, 2026, 31(8): 1064-1066.

/ 推荐

参考文献

[1] Younossi Z M, Golabi P, Paik J M, et al. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review[J]. Hepatology, 2023, 77(4): 1335-1347.
[2] Feng G, Targher G, Byrne C D, et al. Global burden of metabolic dysfunction-associated steatotic liver disease, 2010 to 2021[J]. JHEP Rep, 2024, 7(3): 101271.
[3] Lazarus J V, Agirre-Garrido L, Miralles-Sanchez J E, et al. Cost of metabolic dysfunction-associated steatotic liver disease screening among all people living with diabetes in six countries[J]. Liver Int, 2025, 45(12): e70390.
[4] Lazarus J V, White T M, Agirre-Garrido L, et al. Assessing Europe's policy readiness to confront the MASLD/MASH public health threat[J]. Lancet Reg Health Eur, 2026, 65: 101713.
[5] Lim R Y, Tan F X N, Ho G J K, et al. Incidence of hepatocellular carcinoma in metabolic dysfunction-associated steatotic liver disease: a reconstructed individual patient data meta-analysis[J]. Clin Gastroenterol Hepatol, 2026, 24(5): 1236-1246.
[6] Krag A, Tacke F, Israelsen M, et al. Is liver steatosis a disease or the emperor's new clothes?[J]. J Hepatol, 2026, 84(5): 993-1001.
[7] Tamaki N, Kimura T, Wakabayashi S, et al. Long-term clinical outcomes in steatotic liver disease and incidence of liver-related events, cardiovascular events and all-cause mortality[J]. Aliment Pharmacol Ther, 2024, 60(1): 61-69.
[8] Febbraio M A, Karin M. "Sweet death": fructose as a metabolic toxin that targets the gut-liver axis[J]. Cell Metab, 2021, 33(12): 2316-2328.
[9] Fulham M A, Griffin J D, Perez S, et al. Impaired hepatic metabolism in hereditary fructose intolerance confers fructose-independent risk for steatosis and hypertriglyceridemia[J]. Mol Metab, 2026, 104: 102310.
[10] Osonoi S, Takebe T. Organoid-guided precision hepatology for metabolic liver disease[J]. J Hepatol, 2024, 80(5): 805-821.
[11] Buchl S C, Hanquier Z, Haak A J, et al. Traf2 and NCK interacting kinase is a critical regulator of procollagen I trafficking and hepatic fibrogenesis in mice[J]. Hepatol Commun, 2022, 6(3): 593-609.
[12] Godwin K M, Grigoryan L, Thrift A P, et al. A cluster randomized trial of a multicomponent clinical care pathway (MCCP) to improve MASLD diagnosis and management in primary care: study protocol[J].BMC Health Serv Res, 2025, 25(1): 645.
[13] 范建高,徐小元,南月敏,等. 代谢相关(非酒精性)脂肪性肝病防治指南(2024年版)[J]. 实用肝脏病杂志, 2024, 27(4): 494-510.
[14] Younossi Z M, Krag A, Zelber-Sagi S, et al. Binge drinking, metabolic dysfunction, and the spectrum of steatotic liver disease in the USA: a cross-sectional and longitudinal analysis[J]. Lancet Gastroenterol Hepatol, 2026, 11(6): 495-508.
[15] Kim M, Son M, Moon S Y, et al. Metabolic dysfunction-associated steatotic liver disease, alcohol consumption, and the risk of atrial fibrillation: a nationwide population-based study[J]. J Am Heart Assoc, 2025, 14(14): e42003.
[16] Souto Maior M D R M, Ribeiro N D L I, Silva H V V, et al. Metabolic dysfunction-associated steatotic liver disease as a risk factor for chronic kidney disease: a narrative review[J]. Biomedicines, 2025, 13(9): 2162.
[17] Liu J, Yang F, Gao B, et al. Resmetirom, the first FDA-approved drug for MASH: from drug discovery and action mechanisms to clinical trials[J]. Arch Pharm Res, 2025, 48(11-12): 1299-1313.
[18] Petta S, Kim K, Targher G, et al. Focus on semaglutide 2.4 mg/week for the treatment of metabolic dysfunction-associated steatohepatitis[J]. Liver Int 2025, 45(11): e70407.
[19] Younossi Z M, Razavi H, Sherman M, et al. Addressing the high and rising global burden of metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH): from the growing prevalence to payors′ perspective[J]. Aliment Pharmacol Ther, 2025, 61(9): 1467-1478.
[20] Le P, Tatar M, Dasarathy S, et al. Estimated burden of metabolic dysfunction-associated steatotic liver disease in US adults, 2020 to 2050[J].JAMA Netw Open, 2025, 8(1): e2454707.