代谢相关脂肪性肝病预后风险分型:数据驱动下的探索与展望
DOI: 10.12449/JCH260224
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:王莹负责文献整理及论文撰写;赵雨晴、刘津津负责文献收集及筛选;邓优负责论文内容指导与修订;赵静洁、尤红负责拟定写作思路并最终定稿。
Prognostic risk classification of metabolic dysfunction-associated fatty liver disease: Data-driven exploration and prospect
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摘要: 代谢相关脂肪性肝病是全球最常见的慢性肝病之一,因疾病的复杂性和疾病进展的异质性对精准诊疗提出了严峻挑战。目前常用的临床分型无法满足全面解析该疾病复杂性和不良预后异质性的需求。近年来,基于数据驱动的预后风险分型逐渐涌现,显著优化了不良预后的风险预测能力,提升了不同终点结局的识别精度。然而,这种先分型、后关联结局的模式,存在数据“黑箱”问题,且分型指标各异,临床应用尚不稳定。未来需整合或建立大规模人群队列,以不同临床结局为导向构建预后风险分型模型,整合动态数据,优化分型算法,并通过多人群验证其普适性,为代谢相关脂肪性肝病的精准诊疗提供可靠支撑。
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关键词:
- 代谢功能障碍相关脂肪性肝病 /
- 数据科学 /
- 预后 /
- 精准医学
Abstract: Metabolic dysfunction-associated fatty liver disease (MAFLD), as one of the most common chronic liver diseases in the world, poses a severe challenge to precision diagnosis and treatment due to its complex pathogenesis and highly heterogeneous disease progression. Existing clinical classification systems cannot meet the needs for comprehensively analyzing the complexity of the disease and the heterogeneity of its adverse outcomes. In recent years, data-driven prognostic risk classification methods have gradually emerged, optimizing the ability for predicting adverse outcomes and enhancing the accuracy of identifying different endpoint outcomes. However, such paradigm of “classify first, associate outcomes later” suffers from a “black-box” nature, and there are various indicators for classification, leading to limited stability and generalizability in clinical application. Future research needs to integrate or establish large-scale population cohorts, develop outcome-oriented prognostic risk classification models, incorporate dynamic data, refine classification algorithms, and validate their generalizability across multiple populations, thereby providing reliable support for the precision diagnosis and treatment of MAFLD. -
[1] YOUNOSSI ZM, GOLABI P, PAIK JM, et al. The global epidemiology of nonalcoholic fatty liver disease(NAFLD) and nonalcoholic steatohepatitis(NASH): A systematic review[J]. Hepatology, 2023, 77( 4): 1335- 1347. DOI: 10.1097/HEP.0000000000000004. [2] LE MH, YEO YH, ZOU BY, et al. Forecasted 2040 global prevalence of nonalcoholic fatty liver disease using hierarchical Bayesian approach[J]. Clin Mol Hepatol, 2022, 28( 4): 841- 850. DOI: 10.3350/cmh.2022.0239. [3] LOU TW, YANG RX, FAN JG. The global burden of fatty liver disease: The major impact of China[J]. Hepatobiliary Surg Nutr, 2024, 13( 1): 119- 123. DOI: 10.21037/hbsn-23-556. [4] ZHOU JH, ZHOU F, WANG WX, et al. Epidemiological features of NAFLD from 1999 to 2018 in China[J]. Hepatology, 2020, 71( 5): 1851- 1864. DOI: 10.1002/hep.31150. [5] EASL-EASD-EASO. EASL-EASD-EASO Clinical practice guidelines on the management of metabolic dysfunction-associated steatotic liver disease(MASLD)[J]. J Hepatol, 2024, 81( 3): 492- 542. DOI: 10.1016/j.jhep.2024.04.031. [6] RINELLA ME, NEUSCHWANDER-TETRI BA, SIDDIQUI MS, et al. AASLD practice guidance on the clinical assessment and management of nonalcoholic fatty liver disease[J]. Hepatology, 2023, 77( 5): 1797- 1835. DOI: 10.1097/HEP.0000000000000323. [7] ZHANG C, ZHU PH, HE LL. Research progress on the correlation between metabolic associated fatty liver disease and cardiovascular disease risk[J/CD]. Chin J Liver Dis(Electronic Version), 2025, 17( 1): 12- 18. DOI: 10.3969/j.issn.1674-7380.2025.01.003.张成, 朱平辉, 何玲玲. 代谢相关脂肪性肝病与心血管疾病风险相关性研究现状[J/CD]. 中国肝脏病杂志(电子版), 2025, 17( 1): 12- 18. DOI: 10.3969/j.issn.1674-7380.2025.01.003. [8] ESLAM M, NEWSOME PN, SARIN SK, et al. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement[J]. J Hepatol, 2020, 73( 1): 202- 209. DOI: 10.1016/j.jhep.2020.03.039. [9] RINELLA ME, LAZARUS JV, RATZIU V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature[J]. J Hepatol, 2023, 79( 6): 1542- 1556. DOI: 10.1016/j.jhep.2023.06.003. [10] Chinese Society of Hepatology, Chinese Medical Association. Guidelines for the prevention and treatment of metabolic dysfunction-associated(non-alcoholic) fatty liver disease(Version 2024)[J]. J Pract Hepatol, 2024, 27( 4): 494- 510. DOI: 10.3760/cma.j.cn501113-20240327-00163.中华医学会肝病学分会. 代谢相关(非酒精性)脂肪性肝病防治指南(2024年版)[J]. 实用肝脏病杂志, 2024, 27( 4): 494- 510. DOI: 10.3760/cma.j.cn501113-20240327-00163. [11] TAYLOR RS, TAYLOR RJ, BAYLISS S, et al. Association between fibrosis stage and outcomes of patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis[J]. Gastroenterology, 2020, 158( 6): 1611- 1625. e 12. DOI: 10.1053/j.gastro.2020.01.043. [12] ISRAELSEN M, FRANCQUE S, TSOCHATZIS EA, et al. Steatotic liver disease[J]. Lancet, 2024, 404( 10464): 1761- 1778. DOI: 10.1016/S0140-6736(24)01811-7. [13] SHAIKH SS, QAZI-ARISAR F ALI, NAFAY S, et al. Metabolic puzzle: Exploring liver fibrosis differences in Asian metabolic-associated fatty liver disease subtypes[J]. World J Hepatol, 2024, 16( 1): 54- 64. DOI: 10.4254/wjh.v16.i1.54. [14] YANG TY, YIN JY, LI JN, et al. The influence of different combinations of cardiometabolic risk factors on the prevalence of MASLD and risk of advanced fibrosis deserves attention[J]. J Hepatol, 2024, 80( 2): e82- e85. DOI: 10.1016/j.jhep.2023.09.030. [15] ITO T, MOROOKA H, TAKAHASHI H, et al. Identification of clinical phenotypes associated with poor prognosis in patients with nonalcoholic fatty liver disease via unsupervised machine learning[J]. J Gastroenterol Hepatol, 2023, 38( 10): 1832- 1839. DOI: 10.1111/jgh.16326. [16] RAVERDY V, TAVAGLIONE F, CHATELAIN E, et al. Data-driven cluster analysis identifies distinct types of metabolic dysfunction-associated steatotic liver disease[J]. Nat Med, 2024, 30( 12): 3624- 3633. DOI: 10.1038/s41591-024-03283-1. [17] DING JJ, LIU HZ, ZHANG XX, et al. Integrative multiomic analysis identifies distinct molecular subtypes of NAFLD in a Chinese population[J]. Sci Transl Med, 2024, 16( 772): eadh9940. DOI: 10.1126/scitranslmed.adh9940. [18] VANDROMME M, JUN T, PERUMALSWAMI P, et al. Automated phenotyping of patients with non-alcoholic fatty liver disease reveals clinically relevant disease subtypes[J]. Pac Symp Biocomput, 2020, 25: 91- 102. [19] DONG R, TIAN T, LUO ZH, et al. Cardiometabolic phenotype linked to fibrosis and mortality in metabolic dysfunction-associated steatotic liver disease[J]. Nutr Metab Cardiovasc Dis, 2025, 35( 3): 103797. DOI: 10.1016/j.numecd.2024.103797. [20] HONG C, LIANG SX, LI ZY, et al. Novel subtypes of metabolic associated steatotic liver disease linked to clinical outcomes: Implications for precision medicine[J]. J Transl Med, 2025, 23( 1): 769. DOI: 10.1186/s12967-025-06670-5. [21] JAMIALAHMADI O, de VINCENTIS A, TAVAGLIONE F, et al. Partitioned polygenic risk scores identify distinct types of metabolic dysfunction-associated steatotic liver disease[J]. Nat Med, 2024, 30( 12): 3614- 3623. DOI: 10.1038/s41591-024-03284-0. [22] LEE H, LEE YH, KIM SU, et al. Metabolic dysfunction-associated fatty liver disease and incident cardiovascular disease risk: A nationwide cohort study[J]. Clin Gastroenterol Hepatol, 2021, 19( 10): 2138- 2147. e 10. DOI: 10.1016/j.cgh.2020.12.022. [23] THOMAS JA, KENDALL BJ, DALAIS C, et al. Hepatocellular and extrahepatic cancers in non-alcoholic fatty liver disease: A systematic review and meta-analysis[J]. Eur J Cancer, 2022, 173: 250- 262. DOI: 10.1016/j.ejca.2022.06.051. [24] YE JZ, ZHUANG XD, LI X, et al. Novel metabolic classification for extrahepatic complication of metabolic associated fatty liver disease: A data-driven cluster analysis with international validation[J]. Metabolism, 2022, 136: 155294. DOI: 10.1016/j.metabol.2022.155294. [25] YI JY, WANG LL, GUO JJ, et al. Novel metabolic phenotypes for extrahepatic complication of nonalcoholic fatty liver disease[J]. Hepatol Commun, 2023, 7( 1): e0016. DOI: 10.1097/HC9.0000000000000016. [26] MARTÍNEZ-ARRANZ I, BRUZZONE C, NOUREDDIN M, et al. Metabolic subtypes of patients with NAFLD exhibit distinctive cardiovascular risk profiles[J]. Hepatology, 2022, 76( 4): 1121- 1134. DOI: 10.1002/hep.32427. [27] CARRILLO-LARCO RM, GUZMAN-VILCA WC, CASTILLO-CARA M, et al. Phenotypes of non-alcoholic fatty liver disease(NAFLD) and all-cause mortality: Unsupervised machine learning analysis of NHANES III[J]. BMJ Open, 2022, 12( 11): e067203. DOI: 10.1136/bmjopen-2022-067203. [28] BARREDO ARRIETA A, DÍAZ-RODRÍGUEZ N, DEL SER J, et al. Explainable Artificial Intelligence(XAI): Concepts, taxonomies, opportunities and challenges toward responsible AI[J]. Inf Fusion, 2020, 58: 82- 115. DOI: 10.1016/j.inffus.2019.12.012. -
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