BMJ open gastroenterology · 2025
Liver fibrosis with persistently normal alanine transaminase levels exhibits a distinct treatment response in MASLD.
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Luo Ling, Shao Congxiang, Teng Long, Zhuo Shuyu, Dong Zhi, Wang Wei, Ye Junzhao, Zhong Bihui
Аннотация
OBJECTIVE: Metabolic dysfunction-associated steatotic liver disease (MASLD) presents considerable variability in disease progression and treatment outcomes. We aimed to determine whether specific patterns of liver inflammatory flares are correlated with distinct treatment responses.
METHODS: We conducted an analysis of a well-characterised prospective cohort involving treatment-naïve MASLD patients from January 2015 to November 2023 at The First Affiliated Hospital of Sun Yat-sen University. Participants underwent a standardised 48-week lifestyle modification programme, with follow-up extending through December 2024. Liver fat content (LFC) was assessed using MRI-based proton density fat fraction (MRI-PDFF), whereas liver stiffness measurements (LSMs) were performed using two-dimensional shear wave elastography at baseline and after 48 weeks.
RESULTS: Participants were stratified by alanine transaminase (ALT) and liver fibrosis status: normal ALT/no fibrosis (n=149), elevated ALT/no fibrosis (n=264), normal ALT/fibrosis (n=91) and elevated ALT/fibrosis (n=178). While MRI-PDFF (≥30% LFC decline) and ALT responses (≥17 U/L decrease) did not differ between groups, the elevated ALT/fibrosis group exhibited a significantly higher probability of LSM response (≥1 fibrosis stage improvement) than in the normal ALT/ fibrosis group (53.4% vs 31.9%, p=0.001; OR=2.53, 95% CI: 1.31 to 4.85, p=0.006). Receiver operating characteristic analysis revealed that the cut-offs for weight loss (8.55% vs 4.94%, p=0.023) and LFC reduction (39.85% vs 20.57%, p=0.062) associated with LSM response were higher in patients with normal ALT/fibrosis than in those with elevated ALT/fibrosis.
CONCLUSION: MASLD patients with liver fibrosis and persistently normal ALT levels exhibited a less favourable treatment response to fibrosis than those with elevated ALT levels, necessitating more substantial reductions in steatosis and weight to achieve the desired outcomes.
METHODS: We conducted an analysis of a well-characterised prospective cohort involving treatment-naïve MASLD patients from January 2015 to November 2023 at The First Affiliated Hospital of Sun Yat-sen University. Participants underwent a standardised 48-week lifestyle modification programme, with follow-up extending through December 2024. Liver fat content (LFC) was assessed using MRI-based proton density fat fraction (MRI-PDFF), whereas liver stiffness measurements (LSMs) were performed using two-dimensional shear wave elastography at baseline and after 48 weeks.
RESULTS: Participants were stratified by alanine transaminase (ALT) and liver fibrosis status: normal ALT/no fibrosis (n=149), elevated ALT/no fibrosis (n=264), normal ALT/fibrosis (n=91) and elevated ALT/fibrosis (n=178). While MRI-PDFF (≥30% LFC decline) and ALT responses (≥17 U/L decrease) did not differ between groups, the elevated ALT/fibrosis group exhibited a significantly higher probability of LSM response (≥1 fibrosis stage improvement) than in the normal ALT/ fibrosis group (53.4% vs 31.9%, p=0.001; OR=2.53, 95% CI: 1.31 to 4.85, p=0.006). Receiver operating characteristic analysis revealed that the cut-offs for weight loss (8.55% vs 4.94%, p=0.023) and LFC reduction (39.85% vs 20.57%, p=0.062) associated with LSM response were higher in patients with normal ALT/fibrosis than in those with elevated ALT/fibrosis.
CONCLUSION: MASLD patients with liver fibrosis and persistently normal ALT levels exhibited a less favourable treatment response to fibrosis than those with elevated ALT levels, necessitating more substantial reductions in steatosis and weight to achieve the desired outcomes.