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Esteatohepatite e fibrose hepática associada a disfunção metabólica (MASH) : aplicação de algoritmos de diagnóstico
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Resumo(s)
A Doença hepática esteatótica associada a disfunção metabólica consiste num espetro de patologias e na causa mais comum de doença hepática crónica. Com prevalência de 30% na população adulta, esta designação compreende a Esteatohepatite associada à disfunção metabólica, caraterizada pela acumulação excessiva de lípidos no fígado, associada a inflamação e lesão celular, com possível evolução para fibrose hepática, cirrose e carcinoma hepatocelular. Fatores genéticos, dietéticos e alterações no metabolismo lipídico e glucídico contribuem para a resistência à insulina e desenvolvimento de fibrose hepática, fator determinante no prognóstico da doença. Pretendeu-se estudar a aplicação de algoritmos não invasivos de rastreio na identificação e estratificação do risco de fibrose hepática em indivíduos de risco bem como aferir uma possível correlação entre resistência à insulina e fibrose hepática em utentes pré-diabéticos. Foi realizado um estudo retrospetivo observacional numa coorte de utentes (n=646), com idades entre 35-65 anos, seguidos em ambulatório numa clínica portuguesa entre 2021-2024. Os utentes apresentavam transaminases elevadas e foram estratificados com base na glicemia de jejum em pré-diabéticos e diabéticos. O índice de fibrose FIB-4 tem alto valor preditivo negativo e divide-se em três categorias: baixo risco (<1,3), risco intermédio (>1,3 <2,67) e elevado risco (>2,67). O índice TyG foi calculado em utentes pré-diabéticos com dados de triglicéridos disponíveis (n=45) e avaliada a correlação com FIB-4. Dos 646 utentes, 35,8% apresentaram FIB-4 <1,3, 49% com FIB-4>1,3< 2,67, e 15,2% com FIB-4 > 2,67. Houve taxa semelhante de FIB-4 >1,3 entre pré-diabéticos e diabéticos (63,2% e 65,2%) e uma maior prevalência de FIB-4 >2,67 nos pré-diabéticos (16,2%) em comparação com os diabéticos (14,2%). Estes resultados demonstram a utilidade do rastreio na identificação de utentes em risco de fibrose hepática que necessitam de referenciação. Já a correlação entre FIB-4 e TyG nos pré-diabéticos estudados foi fraca (r=0,26935), sugerindo uma associação limitada entre resistência à insulina e fibrose hepática nesta amostra. Este resultado entre TyG e FIB-4 sugere então que a resistência à insulina não é um fator preditor isolado para fibrose hepática nesta amostra. Estudos subsequentes com dados complementares e outros biomarcadores são necessários na identificação de doentes em risco.
Metabolic dysfunction-associated steatotic liver disease consists of a spectrum of pathologies and is the most common cause of chronic liver disease. With a prevalence of 30% in the adult population, this condition includes metabolic dysfunction-associated steatohepatitis, characterized by excessive lipid accumulation in the liver, associated with inflammation and cellular damage, potentially progressing to liver fibrosis, cirrhosis, and hepatocellular carcinoma. Genetic and dietary factors, along with alterations in lipid and glucose metabolism, contribute to insulin resistance and the development of liver fibrosis, a key prognostic factor. This study aimed to evaluate the use of non-invasive screening algorithms for identifying and stratifying the risk of liver fibrosis in at-risk individuals, as well as to assess a possible correlation between insulin resistance and liver fibrosis in prediabetic patients. A retrospective observational study was conducted on a cohort of 646 patients, aged 35-65, followed in an outpatient clinic in Portugal between 2021 and 2024. These patients presented elevated liver enzymes and were stratified based on fasting glucose levels into prediabetic and diabetic groups. The FIB-4 fibrosis index, which has a high negative predictive value, was used to classify patients into three risk categories: low (<1.3), intermediate (1.3-2.67), and high (>2.67). The TyG index was calculated for prediabetic patients with available triglyceride data (n=45) to assess its correlation with FIB-4. Among the 646 patients, 35,8% had FIB-4 <1,3, 49% had FIB-4 >1,3<2,67, and 15,2% had FIB-4 >2,67. The proportion of FIB-4 >1,3 was similar between prediabetics and diabetics (63,2% and 65,2%, respectively), but prediabetics had a slightly higher prevalence of FIB-4 >2,67 (16,2% vs. 14,2%). These results highlight the usefulness of screening in identifying patients at risk of liver fibrosis who require further evaluation. The correlation between FIB-4 and TyG in the prediabetic group was weak (r=0,26935), suggesting a limited association between insulin resistance and liver fibrosis in this sample. The weak correlation between TyG and FIB-4 suggests that insulin resistance is not an isolated predictive factor for liver fibrosis in this sample. Further studies with additional data and other biomarkers are necessary for identifying at-risk patients.
Metabolic dysfunction-associated steatotic liver disease consists of a spectrum of pathologies and is the most common cause of chronic liver disease. With a prevalence of 30% in the adult population, this condition includes metabolic dysfunction-associated steatohepatitis, characterized by excessive lipid accumulation in the liver, associated with inflammation and cellular damage, potentially progressing to liver fibrosis, cirrhosis, and hepatocellular carcinoma. Genetic and dietary factors, along with alterations in lipid and glucose metabolism, contribute to insulin resistance and the development of liver fibrosis, a key prognostic factor. This study aimed to evaluate the use of non-invasive screening algorithms for identifying and stratifying the risk of liver fibrosis in at-risk individuals, as well as to assess a possible correlation between insulin resistance and liver fibrosis in prediabetic patients. A retrospective observational study was conducted on a cohort of 646 patients, aged 35-65, followed in an outpatient clinic in Portugal between 2021 and 2024. These patients presented elevated liver enzymes and were stratified based on fasting glucose levels into prediabetic and diabetic groups. The FIB-4 fibrosis index, which has a high negative predictive value, was used to classify patients into three risk categories: low (<1.3), intermediate (1.3-2.67), and high (>2.67). The TyG index was calculated for prediabetic patients with available triglyceride data (n=45) to assess its correlation with FIB-4. Among the 646 patients, 35,8% had FIB-4 <1,3, 49% had FIB-4 >1,3<2,67, and 15,2% had FIB-4 >2,67. The proportion of FIB-4 >1,3 was similar between prediabetics and diabetics (63,2% and 65,2%, respectively), but prediabetics had a slightly higher prevalence of FIB-4 >2,67 (16,2% vs. 14,2%). These results highlight the usefulness of screening in identifying patients at risk of liver fibrosis who require further evaluation. The correlation between FIB-4 and TyG in the prediabetic group was weak (r=0,26935), suggesting a limited association between insulin resistance and liver fibrosis in this sample. The weak correlation between TyG and FIB-4 suggests that insulin resistance is not an isolated predictive factor for liver fibrosis in this sample. Further studies with additional data and other biomarkers are necessary for identifying at-risk patients.
Descrição
Tese de mestrado, Análises Clínicas, 2025, Universidade de Lisboa, Faculdade de Farmácia.
Palavras-chave
204219213 MASLD MASH Fibrose hepática Score FIB-4 Índice TyG Teses de mestrado -2025