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肝硬化是疾病还是皇帝的新衣服?
Aleksander Krag1, Frank Tacke2, Mads Israelsen1
1Department of Gastroenterology & Hepatology, Odense University Hospital, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark.
Journal of hepatology
|January 19, 2026
概括
与代谢功能障碍相关的脂肪性肝病 (MASLD) 是常见的,但很少进展. 只有带有纤维化的脂肪肝炎 (MASH) 需要肝脏特异性治疗,使其与良性脂肪积累区别开来.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 代谢疾病 代谢疾病
- 肝脏病理病理 肝脏病理病理
背景情况:
- 将脂肪性肝病重新定义为MASLD和MASH,澄清了良性脂肪积累与病理的区别.
- MASLD在全球范围内影响了25-30%,但只有少数人进展到晚期的肝病.
- 隔离脂肪是风险标志物,而不是疾病本身,与纤维化MASH不同.
研究的目的:
- 为了准确的风险评估和管理,区分MASLD和有纤维化的MASH.
- 根据疾病阶段指导有针对性的监测和治疗.
- 支持以代谢健康和纤维化预防为重点的公共卫生战略.
主要方法:
- 对MASLD和MASH的当前定义和全球流行数据的审查.
- 在MASLD/MASH中分析肝脏不良结果的风险因素,包括纤维化阶段.
- 治疗影响的评估基于隔离脂肪酸和有纤维化的MASH之间的区别.
主要成果:
- MASLD的患病率很高 (25-30%),但具有显著纤维化的MASH较少 (估计为5%).
- 肝纤维化阶段,代谢功能障碍的严重程度和其他因素决定了不良结果.
- 隔离性肥胖症需要心脏代谢管理,而MASH/纤维化需要针对肝脏的干预措施.
结论:
- 对精确的风险沟通和资源分配来说,区分肉和MASH/纤维化至关重要.
- 这种范式转变使得基于证据的公共卫生战略能够促进代谢健康和纤维化预防.
- 准确的诊断指导适当的监测和治疗,防止不必要的患者警报和医疗保健系统压力.
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