对临床上可用的活检药物疗法的分析证实了与脂肪肝相关的代谢功能障碍 (MASH)
Emily Wood1, Rukayat Akande1, Iqra Iqbal1
1Department of Internal Medicine, Division of Endocrinology, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
Diabetes, obesity & metabolism
|December 9, 2025
概括
药物有效地逆转与代谢相关的脂肪性肝病 (MASLD) 和MASH. 纤维化解消的改善在早期疾病阶段更为显著,这表明早期干预有好处.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 药理学 药理学是指药理学的学科.
- 胃肠病学 胃肠病学
背景情况:
- 与代谢相关的脂肪性肝病 (MASLD) 和其炎症形式MASH正在引起越来越多的健康问题.
- 对MASH的药物治疗通常保留给中度至重度纤维化 (2-3级) 患者.
研究的目的:
- 用随机对照试验 (RCT) 的数据与肝脏活检结果来评估MASH临床可用的药物的治疗益处.
- 评估这些疗法对MASH活动得分和纤维化进展的影响.
主要方法:
- 在PubMed,Cochrane和Scopus数据库中对相关RCT进行了系统的文献搜索.
- 在元分析和元回归分析中,包含了14篇关于肝活检数据的出版物.
- 评估的结果包括MASLD活动得分 (MAS),纤维化等级,MASH无纤维化恶化 (RSw/oF) 的解决和MASH无纤维化恶化 (RFw/oS) 的纤维化阶段减少的变化.
主要成果:
- 与安慰剂相比,药物治疗显著改善了MASLD活动得分 (MAS) (p < 0.001).
- 特定的药物,如达帕格利弗洛辛,塞马格卢提德和皮奥格利塔,在MAS子得分 (肥胖症,炎症,气球膨胀) 中显示出改善.
- 纤维化等级有所改善 (p < 0.001),关键药物 (resmetirom,semaglutide,tirzepatide,dapagliflozin) 显示出RSw/oF和RFw/oS的显著率 (p < 0.015).
- 在较低基线纤维化度的患者中,RSw/oF和RFw/oS的改善更大.
结论:
- 临床上可用的药物在逆转MASH时表现出有效性.
- 肝纤维化的早期阶段显示这些疗法带来了更大的改善.
- 未来的研究应该在药物效应分析中考虑基线纤维化水平,并探索MASLD早期预防治疗的长期益处.
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