PDF(Pubmed)
Abstract：
In this editorial, we comment on the article by Chen et al recently published in 2024. We focus the debate on whether reducing the upper limit of normal of alanine aminotransferase (ALT) would effectively identify cases of fibrosis in metabolic-dysfunction associated fatty liver disease (MAFLD). This is important given the increasing prevalence of MAFLD and obesity globally. Currently, a suitable screening test to identify patients in the general population does not exist and most patients are screened after the finding of an abnormal ALT. The authors of this paper challenge the idea of what a normal ALT is and whether that threshold should be lowered, particularly as their study found that 83.12% of their study population with a diagnosis of MAFLD had a normal ALT. The main advantages of screening would be to identify patients and provide intervention early, the mainstay of this being changing modifiable risk factors and monitoring for liver fibrosis. However, there is not enough suitable therapeutic options available as of yet although this is likely to change in the coming years with more targets for therapy being discovered. Semaglutide is one example of this which has demonstrated benefit with an acceptable side effect profile for those patients with MAFLD and obesity, although studies have not yet shown a significant improvement in fibrosis regression. It would also require a huge amount of resource if a reduced ALT level alone was used as criteria; it is more likely that current scoring systems such as fibrosis-4 may be amended to represent this additional risk. Currently, there is not a good argument to recommend widespread screening with a reduced ALT level as this is unlikely to be cost-effective. This is compounded by the fact that there is a significant heterogeneity in what is considered a normal ALT between laboratories. Although studies previously have suggested a more pragmatic approach in screening those over the age of 60, this is likely to change with the increasing incidence of obesity within the younger age groups. The main message from this study is that those who have hypercholesterolemia and high body metabolic index should have these risk factors modified to maintain a lower level of ALT to reduce the risk of progression to fibrosis and cirrhosis.
摘要：
在这篇社论中，我们评论了Chen等人最近在2024年发表的文章。我们将重点放在降低丙氨酸转氨酶（ALT）的正常上限是否会有效识别代谢功能障碍相关脂肪肝（MAFLD）的纤维化病例上。鉴于全球MAFLD和肥胖症的患病率不断增加，这一点很重要。目前,在普通人群中不存在用于识别患者的合适筛查试验,大多数患者在发现ALT异常后进行筛查.本文的作者质疑什么是正常ALT以及是否应该降低该阈值的想法，特别是他们的研究发现,83.12%的被诊断为MAFLD的研究人群ALT正常.筛查的主要优点是识别患者并提供早期干预，这主要是改变可改变的危险因素和监测肝纤维化。然而,目前还没有足够的合适的治疗选择，尽管随着更多的治疗靶点被发现，这种情况在未来几年可能会发生变化。Semaglutide是其中的一个例子，它已经证明对MAFLD和肥胖患者具有可接受的副作用。尽管研究尚未显示纤维化消退的显着改善。如果单独使用降低的ALT水平作为标准，也需要大量的资源;更有可能的是，目前的评分系统，如纤维化-4可以被修改以代表这种额外的风险。目前,没有一个很好的论据来推荐ALT水平降低的广泛筛查,因为这不太可能具有成本效益.这与实验室之间被认为是正常ALT的存在显著异质性的事实更加复杂。尽管以前的研究已经提出了一种更务实的方法来筛查60岁以上的人群，但这可能会随着年轻年龄组肥胖发生率的增加而改变。这项研究的主要信息是，那些患有高胆固醇血症和高身体代谢指数的人应该修改这些危险因素，以维持较低的ALT水平，以减少进展为纤维化和肝硬化的风险。
