Specific metabolic impairments indicate loss of sustained liver improvements in metabolic dysfunction-associated steatotic liver disease treatment  

作　　者：Ling Luo Junzhao Ye Shuyu Zhuo Bo Ma Weiyi Mai Xiaopei Cao Liuqin Liang Wei Wang Shiting Feng Zhi Dong Bihui Zhong 

机构地区：[1]Department of Gastroenterology,The First Affiliated Hospital,Sun Yat-sen University,Guangzhou,China [2]Department of Nutrition,The First Affiliated Hospital,Sun Yat-sen University,Guangzhou,China [3]Department of Gastroenterology,The East Division of the First Affiliated Hospital,Sun Yat-sen University,Guangzhou,China [4]Department of Cardiology,The First Affiliated Hospital,Sun Yat-sen University,Guangzhou,China [5]Department of Endocrinology,The First Affiliated Hospital,Sun Yat-sen University,Guangzhou,China [6]Department of Rheumatology,The First Affiliated Hospital,Sun Yat-sen University,Guangzhou,China [7]Department of Ultrasound,The First Affiliated Hospital,Sun Yat-sen University,Guangzhou,China [8]Department of Radiology,The First Affiliated Hospital,Sun Yat-sen University,Guangzhou,China

出　　处：《Hepatobiliary Surgery and Nutrition》2024年第4期632-649,I0025-I0035,共29页肝胆外科与营养（英文）

基　　金：National Natural Science Foundation of China(grant Nos.81870404 and 82100648);Natural Science Foundation of Guangdong Province,China(grant Nos.2021A1515011442 and 2022A1515012369);China Postdoctoral Science Foundation(grant No.2020M683128).

摘　　要：Background:High liver fat content(LFC)induces increased risks of both hepatic and extrahepatic progression in metabolic dysfunction-associated steatotic liver disease(MASLD),while maintaining a significant decline in magnetic resonance imaging-based proton density fat fraction(MRI-PDFF)(≥30%decline relative to baseline)without worsening fibrosis results in improved histological severity and prognosis.However,the factors associated with the loss of sustained responses to treatment remain unclear,and we aim to identify them.Methods:Consecutive treatment-naïve MASLD patients between January 2015 and February 2022,with follow-up until April 2023,were included in this prospective cohort study.LFC quantified by MRI-PDFF and liver stiffness measurements(LSM)determined by two-dimensional shear wave elastography(2D-SWE)were evaluated at weeks 0,24 and 48.MRI-PDFF response was defined as a≥30%relative decline in PDFF values,and LSM response was defined as a≥1 stage decline from baseline.Results:A total of 602 MASLD patients were enrolled.Of the 303 patients with a 24-week MRI-PDFF response and complete follow-up of 48 weeks,the rate of loss of MRI-PDFF response was 29.4%,and multivariable logistic regression analyses showed that 24-week insulin resistance(IR),still regular exercise and caloric restriction after 24 weeks,and the relative decline in LFC were risk factors for loss of MRI-PDFF response.Loss of LSM response at 48 weeks occurred in 15.9%of patients,and multivariable analysis confirmed 24-week serum total bile acid(TBA)levels and the relative decline in TBA from baseline as independent predictors.No significant association was found at 48 weeks between loss of MRI-PDFF response and loss of LSM response.Conclusions:MASLD patients with IR and high TBA levels are at higher risks of subsequent diminished sustained improvements of steatosis and fibrosis,respectively.

关 键 词：Metabolic dysfunction-associated steatotic liver disease(MASLD) loss of response magnetic resonance imaging-based proton density fat fraction response(MRI-PDFF response) liver stiffness measurements response(LSM response) 

分 类 号：R575[医药卫生—消化系统]