《2025年美国糖尿病学会共识报告:糖尿病患者代谢功能障碍相关脂肪性肝病的筛查和早期干预》摘译
DOI: 10.12449/JCH251007
An excerpt of the consensus report of the American Diabetes Association on the need for screening and early intervention of metabolic dysfunction-associated steatotic liver disease in people with diabetes (2025 edition)
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摘要: 代谢功能障碍相关脂肪性肝病(MASLD)在糖尿病患者中危害严重,但认知不足。约2/3的2型糖尿病患者合并MASLD,其肝硬化、肝癌及肝脏相关死亡风险显著增加,同时与心血管疾病、肝外恶性肿瘤及糖尿病进展密切相关。然而,MASLD的筛查和管理在糖尿病诊疗中仍未得到足够重视。本共识强调应对糖尿病前期和2型糖尿病患者(尤其是肥胖者)进行肝纤维化筛查与风险分层,内容涵盖MASLD术语更新的病理生理学依据、风险分层策略、现有治疗方案(生活方式干预及药物选择)、长期监测方案,以及多学科协作的重要性。此外,探讨了饮酒对肝脏健康的影响。通过提高临床医师和患者对MASLD的认知,并将肝纤维化筛查纳入糖尿病管理流程,有望改善患者长期预后,降低肝硬化的发生率。
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关键词:
- 糖尿病 /
- 代谢功能障碍相关脂肪性肝病 /
- 美国 /
- 诊疗准则
Abstract: Metabolic dysfunction-associated steatotic liver disease (MASLD) poses significant threats to patients with diabetes, but there is still a lack of adequate understanding. About two-thirds of the patients with type 2 diabetes are comorbid with MASLD, which significantly increases the risk of liver cirrhosis, liver cancer, and liver-related mortality and is closely associated with the progression of cardiovascular diseases, extrahepatic malignancies, and diabetes. However, the screening and management of MASLD are not taken seriously in the diagnosis and treatment of diabetes. This consensus report highlights the need for liver fibrosis screening and risk stratification in patients with prediabetes and type 2 diabetes, especially those with obesity, covering the following aspects: the pathophysiological rationale for updated MASLD terminology, the strategies for risk stratification, current treatment regimens (lifestyle interventions and pharmacotherapy), long-term monitoring protocols, and the importance of multidisciplinary collaboration. In addition, it discusses the impact of alcohol consumption on liver health. By enhancing the awareness of MASLD among clinicians and patients and incorporating liver fibrosis screening into standard diabetes management, it is expected to improve the long-term prognosis of patients and reduce the incidence rate of liver cirrhosis. -
表 1 糖尿病前期和糖尿病患者中MASLD的临床意义
Table 1. Clinical implications of MASLD in people with prediabetes and diabetes
·糖尿病前期和2型糖尿病成年
患者发生MASLD的风险最高所有糖尿病前期和2型糖尿病成年患者(尤其合并肥胖者)均应进行MASLD及肝纤维化风险评估 ·严重肝病风险显著增加 伴有临床显著肝纤维化(≥F2期)的MASLD患者的肝硬化、肝癌及肝相关总体死亡率风险会显著
增加·已成为肝移植的首要病因 20%的2型糖尿病患者因MASLD而存在肝硬化高风险,这使MASLD成为美国肝移植的主要原因
之一·更易出现多种全身性合并症 MASLD会加速以下病理进程:糖尿病前期→2型糖尿病、心血管疾病、肝外恶性肿瘤 ·对生活质量产生显著负面影响 MASLD导致健康相关生活质量下降,医疗费用增加 ·强调早期诊断的临床重要性 及时识别和规范管理可阻断MASLD患者肝纤维化进展至肝硬化 -
[1] CUSI K, ABDELMALEK MF, APOVIAN CM, et al. Metabolic dysfunction-associated steatotic liver disease(MASLD) in people with diabetes: The need for screening and early intervention. A consensus report of the American Diabetes Association[J]. Diabetes Care, 2025, 48( 7): 1057- 1082. DOI: 10.2337/dci24-0094. -

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