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2型糖尿病中的MASH:病理生理学,诊断和治疗管理-一篇叙述性评论
Adela Gabriela Ştefan1, Adina Mitrea2, Diana Clenciu2
1Department of Diabetes, Nutrition and Metabolic Diseases, Calafat Municipal Hospital, 205200 Calafat, Romania.
Medicina (Kaunas, Lithuania)
|February 27, 2026
概括
代谢功能障碍相关的脂肪性肝病 (MASLD) 和2型糖尿病 (T2DM) 相互恶化,增加肝病进展和并发症的风险. 早期诊断和风险分层是有效管理和改善患者结果的关键.
科学领域:
- 肝病学和代谢疾病
- 胃肠病学 胃肠病学
- 内分泌学 在内分泌学.
背景情况:
- 代谢功能障碍相关的脂肪性肝病 (MASLD) 是一个日益严重的公共卫生问题,通常先于代谢功能障碍相关的脂肪性肝炎 (MASH) 等晚期肝病.
- MASLD和2型糖尿病 (T2DM) 具有双向关系,MASLD增加T2DM发病率,T2DM加速MASH的进展.
- MASH是肝移植的主要原因,并与严重的并发症有关,包括肝硬化,肝细胞癌 (HCC),慢性病和心血管疾病.
研究的目的:
- 突出MASLD,T2DM及其共同风险因素之间的关键联系.
- 强调准确诊断和纤维化风险分层在MASLD/MASH管理中的重要性.
- 审查对MASLD/MASH和相关T2DM的当前和新兴治疗策略.
主要方法:
- 关于MASLD,MASH,T2DM和相关代谢障碍的当前文献的综述.
- 讨论包括非侵入性标记物 (FIB-4指数) 和成像 (FibroScan) 在内的诊断工具.
- 分析MASH组织学特征和炎症在HCC发展中的作用.
主要成果:
- MASLD和T2DM相互加剧,增加肝病进展和全身并发症的风险.
- 炎症是MASH中HCC的关键驱动因素,无论纤维化程度如何.
- 减肥 (>10%) 对于生活方式管理至关重要;Resmetirom适用于F2/F3纤维化阶段.
结论:
- 准确的诊断和MASLD纤维化阶段测定对于指导治疗决策至关重要,平衡生活方式干预与药理疗法.
- 在MASLD/MASH患者中,首选的T2DM治疗包括GLP-1受体激动剂/辅激剂,SGLT-2抑制剂,甲胺和胰岛素.
- 目前正在进行的临床试验有望完善管理策略,改善MASH患者的生活质量和长期结果.
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