对非酒精性脂肪性肝病 (NAFLD) /与代谢功能障碍相关的脂肪性肝病 (MASLD) 助长心血管风险的系统审查的证据
Nehal K Bhatt1, Yashasvi Agarwal2,3, Sanathanan Neelakantan Ramaswamy4
1Internal Medicine, Pramukhswami Medical College, Karamsad, IND.
Cureus
|September 5, 2025
概括
与代谢功能障碍相关的脂肪酸性肝病 (MASLD) 显著增加心血管疾病的风险,特别是晚期肝纤维化. 早期评估和有针对性的治疗对于应对这种日益严重的健康问题至关重要.
科学领域:
- 心脏病学和肝病学
- 代谢综合征研究
- 公共卫生和流行病学
背景情况:
- 非酒精性脂肪性肝病 (NAFLD),现在是代谢功能障碍相关的脂肪性肝病 (MASLD),对心血管疾病 (CVD) 的风险越来越担忧.
- 由于代谢因素的混和研究方法的多样性,MASLD对心血管疾病的独立贡献受到争论.
- 了解肝纤维化,代谢功能障碍和心血管结果之间的相互作用对于有效的风险分层至关重要.
研究的目的:
- 系统地审查和综合MASLD与心血管结局之间的相关证据.
- 评估肝纤维化严重程度和代谢功能障碍对MASLD患者心血管风险的影响.
- 评估现有证据的质量,并确定未来研究的缺口,包括需要随机试验.
主要方法:
- 根据PRISMA 2020指南进行系统审查,搜索主要数据库 (PubMed,ScienceDirect,欧洲PMC,Cochrane图书馆) 到2025年5月.
- 包括观察性研究和试验来评估MASLD (通过成像,活检或FLI/FIB-4等验证得分) 和心血管结局 (MI,中风,心血管疾病死亡率,动脉样硬化).
- 两个审查员独立提取数据并进行偏差风险评估 (NOS/Cochrane RoB 2).
主要成果:
- 包括21项研究 (18个队列,2个横截面,1个RCT),样本大小高达950万.
- MASLD与心血管风险增加呈现一致的剂量依赖关系 (调整后的HR从1.2至8.0).
- 晚期纤维化 (FIB-4>2. 67) 增加了心血管疾病风险的四倍 (HR>4. 5),更高的代谢负担 (≥4个风险因素) 显著增加了风险 (HR=8. 04).
结论:
- 随着肝纤维化和代谢并发症的严重程度,MASLD是一个显著的独立心血管不良结果的风险因素.
- 虽然MASLD作为一个独立的因素,但它也作为代谢功能障碍的标志物,突出了复杂的病理生理学.
- 支持将非侵入性纤维化评估纳入心血管疾病风险分层;需要进一步的研究,包括RCT,以测试针对心血管疾病的MASLD治疗方法.
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