代谢功能障碍相关脂肪变性肝病(MASLD),以前称为非酒精性脂肪性肝病(NAFLD),定义为在存在一种或多种心脏代谢危险因素和不存在有害酒精摄入的情况下的脂肪变性肝病(SLD)。MASLD的频谱包括脂肪变性,代谢功能障碍相关脂肪性肝炎(MASH,以前是NASH),纤维化,肝硬化和MASH相关的肝细胞癌(HCC)。EASL-EASD-EASO联合指南更新了定义,预防,筛选,MASLD的诊断和治疗。肝纤维化MASLD的病例发现策略,使用非侵入性测试,应应用于有心脏代谢危险因素的个体,肝脏酶异常和/或肝脏脂肪变性的放射学体征,特别是在存在2型糖尿病或肥胖以及其他代谢危险因素的情况下。使用基于血液的评分(如纤维化-4指数[FIB-4])和,顺序,成像技术(如瞬时弹性成像)适用于排除/晚期纤维化,这是肝脏相关结果的预测。在患有MASLD的成年人中,改变生活方式-包括减肥,饮食变化,体育锻炼和抑制饮酒-以及对合并症的最佳管理-包括使用基于肠促胰岛素的疗法(例如,tirzepatide)用于2型糖尿病或肥胖症,如果指示-建议。减肥手术也是MASLD和肥胖症患者的一种选择。如果当地批准并依赖于标签,非肝硬化MASH和显着肝纤维化(阶段≥2)的成年人应考虑使用resmetirom进行MASH靶向治疗,这证明了对脂肪性肝炎和纤维化的组织学有效性,具有可接受的安全性和耐受性。目前,肝硬化阶段没有推荐MASH靶向药物治疗。MASH相关肝硬化的管理包括代谢药物的适应,营养咨询,门脉高压和肝癌的监测,以及失代偿期肝硬化的肝移植。
Metabolic dysfunction-associated steatotic liver disease (MASLD), previously termed non-alcoholic fatty liver disease (NAFLD), is defined as steatotic liver disease (SLD) in the presence of one or more cardiometabolic risk factor(s) and the absence of harmful alcohol intake. The spectrum of MASLD includes steatosis, metabolic dysfunction-associated steatohepatitis (MASH, previously NASH), fibrosis, cirrhosis and MASH-related hepatocellular carcinoma (HCC). This joint EASL-EASD-EASO
guideline provides an update on definitions, prevention, screening, diagnosis and treatment for MASLD. Case-finding strategies for MASLD with liver fibrosis, using non-invasive tests, should be applied in individuals with cardiometabolic risk factors, abnormal liver enzymes and/or radiological signs of hepatic steatosis, particularly in the presence of type 2 diabetes or obesity with additional metabolic risk factor(s). A stepwise approach using blood-based scores (such as the fibrosis-4 index [FIB-4]) and, sequentially, imaging techniques (such as transient elastography) is suitable to rule-out/in advanced fibrosis, which is predictive of liver-related outcomes. In adults with MASLD, lifestyle modification-including weight loss, dietary changes, physical exercise and discouraging alcohol consumption-as well as optimal management of comorbidities-including use of incretin-based therapies (e.g. semaglutide, tirzepatide) for type 2 diabetes or obesity, if indicated-is advised. Bariatric surgery is also an option in individuals with MASLD and obesity. If locally approved and dependent on the label, adults with non-cirrhotic MASH and significant liver fibrosis (stage ≥2) should be considered for a MASH-targeted treatment with resmetirom, which demonstrated histological effectiveness on steatohepatitis and fibrosis with an acceptable safety and tolerability profile. No MASH-targeted pharmacotherapy can currently be recommended for the cirrhotic stage. Management of MASH-related cirrhosis includes adaptations of metabolic drugs, nutritional counselling, surveillance for portal hypertension and HCC, as well as liver transplantation in decompensated cirrhosis.