编者按
2024年7月25日至28日，2024年新加坡GIHep与肝病联合大会（Combined GlHep & SHC 2024）在新加坡举办。本次会议汇聚了全球肝病领域的精英学者，共同探讨肝病的最新进展、挑战与机遇。《国际肝病》特邀中国香港中文大学Vincent Wong教授围绕代谢相关性脂肪性肝病（MAFLD）的流行病学、瘦型MAFLD等相关问题进行了深入探讨。
《国际肝病》
目前全球脂肪肝，特别是MAFLD的最新流行数据有哪些？与过去相比，脂肪肝的流行趋势有何显著变化？
Vincent Wong教授：MAFLD的流行病学正在发生变化。近期，Younossi博士团队进行的系统评价和荟萃分析为我们提供了宝贵的数据。他们综合了所有已公布的研究，结果显示，MAFLD的患病率正在上升，成年人中的总体患病率已接近38%。这个数字令人震惊，相较于20年前的约20%，现在的患病率几乎翻了一番。随之而来的是肝硬化、终末期肝病和肝癌患者比例的上升。因此，MAFLD已成为一个需要我们高度关注的大流行病。
Hepatology Digest：Can you share the current global prevalence of fatty liver disease, especially MAFLD? What are the latest data supporting this, and how have the trends changed compared to the past?
Professor Wong：The epidemiology of MAFLD is evolving. The most comprehensive data come from a recent systematic review and meta-analysis conducted by Dr. Younossi's team. Their findings indicate that the prevalence of MAFLD in the general adult population is now close to 38%. This is a significant increase from about 20% twenty years ago. This rise correlates with an increase in cases of cirrhosis, end-stage liver disease, and liver cancer associated with NAFLD. It's an alarming trend that demands attention.
《国际肝病》
瘦型MAFLD患者与肥胖MAFLD患者的临床特征有何差异？在治疗方面有何区别？
Vincent Wong教授：有趣的是，尽管MAFLD通常与肥胖和其他代谢风险因素紧密相关，但仍有10%~20%的患者属于瘦型MAFLD，即他们的体重指数（BMI）是正常的。根据国际定义，瘦型MAFLD患者指BMI＜25 kg/m²（非亚洲人群），BMI＜23 kg/m²（亚洲人群）。
一般来说，瘦型MAFLD患者的病情相对较轻，但有时也会出现轻度肝炎或晚期纤维化的情况。在疾病管理方面，我们采用相似的评估方法，利用非侵入性检查来评估疾病的严重程度。目前我们对瘦型MAFLD的治疗还不够深入，但生活方式调整被证明是有效的治疗措施。体重减轻与MAFLD的改善之间存在剂量反应关系。
值得注意的是，瘦型患者无需像超重或肥胖患者那样大幅度减重，就能获得同样的健康获益。
Hepatology Digest：What are the clinical differences between lean MAFLD patients and those who are obese? How does their treatment differ?
Professor Wong：Interestingly, while MAFLD is strongly linked to obesity and metabolic risk factors, approximately 10-20% of individuals with MAFLD areified as lean, with a body mass index (BMI) of less than 25 in general or less than 23 in the Asian population. Lean individuals generally have less severe MAFLD, but they can still develop steatohepatitis and advanced fibrosis. In terms of management, the assessment methods are quite similar; we use the same non-invasive tests to evaluate disease severity. Lifestyle modification remains effective, with a dose-response relationship between weight reduction and liver disease improvement. Lean individuals don't need to lose as much weight to achieve similar benefits as their overweight and obese counterparts.
《国际肝病》
瘦型MAFLD患者一般无显著临床症状，未表现出BMI水平的异常，通常不会常规筛查MAFLD。请问该如何及时发现瘦型MAFLD患者并进行治疗呢？
Vincent Wong教授：目前，我们没有足够的数据支持对所有人群进行MAFLD筛查。对于瘦型MAFLD患者，如果他们没有其他代谢风险因素或异常情况，我们并不建议进行MAFLD的常规筛查。如果这些瘦型MAFLD存在其他心血管代谢风险因素，特别是2型糖尿病，那么我们可能需要关注并检测他们的肝脏健康状况。此外，如果患者出现异常的肝生化指标，或者非侵入性检查提示可能存在晚期肝病，我们应该进行相应的深入检查，以便及时发现并治疗肝病。
Hepatology Digest：Given that patients with lean MAFLD often do not show significant clinical symptoms or abnormal BMI levels, routine screening is not usually performed. How can we timely detect and treat MAFLD in these patients?
Professor Wong：Currently, there is no data to support population-wide screening for MAFLD, regardless of metabolic profile. For lean individuals without any risk factors or abnormalities, I would not recommend routine assessment for MAFLD. However, if an individual has other cardiometabolic risk factors, particularly type 2 diabetes, it may be prudent to evaluate for liver disease. Additionally, if someone presents with abnormal liver biochemistry or non-invasive test results suggestive of advanced liver disease, a thorough workup is necessary.
