酒精性与代谢功能障碍相关脂肪性肝病的比较流行病学和代谢特征分析：一项印度西部横断面分析

摘要(中文译文)

脂肪性肝病的全球负担正在不断加剧，其中酒精性肝病（ALD）与代谢功能障碍相关脂肪性肝病（MASLD）代表了不同的病因学途径。近期的命名变更和不断演变的流行病学状况使得当代的比较分析成为必要，尤其是在印度等研究不足的人群中。本研究旨在描述和比较印度西部酒精性脂肪性肝病（AFLD）与MASLD患者的人口学、人体测量学和代谢特征。于2023年6月至2024年12月开展了一项基于医院的分析性横断面研究。参与者被分为三组：AFLD组（n=30）、MASLD组（n=30）和健康对照组（n=30）。各组间性别分布具有可比性，但年龄未进行正式匹配；相反，年龄作为协变量纳入回归分析以校正潜在混杂因素。诊断经超声确认。综合临床数据（包括代谢合并症）采用方差分析（ANOVA）、卡方检验和二元logistic回归进行分析（SPSS v25.0，2017年发布；IBM Corp.，美国纽约州阿蒙克，α=0.05）。出现了显著的组间差异：MASLD患者较年轻（45.1±9.8岁），而AFLD患者为（52.5±10.2岁，p=0.032）。两组均表现为肥胖（体质指数（BMI）：AFLD 31.2±3.5 kg/m²，MASLD 32.8±4.1 kg/m²，p<0.001，对照组为24.5±2.8 kg/m²）。代谢合并症的聚集模式不同：MASLD组糖尿病患病率为46.7%（14/30），而AFLD组为40.0%（12/30）（与对照组比较p=0.002）。高血压影响53.3%（16/30）的MASLD患者和50.0%（15/30）的AFLD患者（p=0.005）。血脂异常患病率相当（AFLD 60.0%（18/30），MASLD 60.0%（18/30），与对照组比较p<0.001）。AFLD患者报告的平均酒精摄入量为65.7±22.1 g/天。MASLD发病更早，伴有密集的代谢聚集，而AFLD发病较晚，伴有显著的酒精暴露。这些不同的表型提示不同的致病轨迹，需要针对性的筛查和管理。AFLD中较高的代谢负担凸显了病因的重叠和潜在的协同肝毒性。

Abstract

The global burden of steatotic liver disease is escalating, with alcoholic liver disease (ALD) and metabolic dysfunction‑associated steatotic liver disease (MASLD) representing distinct etiological pathways. Recent nomenclature changes and evolving epidemiology necessitate contemporary comparative analyses, particularly in understudied populations such as India. This study aimed to characterize and compare the demographic, anthropometric, and metabolic profiles of patients with alcoholic fatty liver disease (AFLD) and MASLD in Western India. A hospital‑based analytical cross‑sectional study was conducted from June 2023 to December 2024. Participants were stratified into three groups: AFLD (n=30), MASLD (n=30), and healthy controls (n=30). Sex distribution was comparable across groups, but age was not formally matched; instead, age was included as a covariate in regression analyses to adjust for potential confounding. Diagnosis was ultrasonographically confirmed. Comprehensive clinical data, including metabolic comorbidities, were analyzed using analysis of variance (ANOVA), chi‑square tests, and binary logistic regression (SPSS v25.0, released 2017; IBM Corp., Armonk, New York, United States, α=0.05). Significant inter‑group differences emerged: Patients with MASLD presented younger (45.1±9.8 years) versus AFLD (52.5±10.2 years, p=0.032). Both groups exhibited obesity (body mass index (BMI): AFLD 31.2±3.5 kg/m², MASLD 32.8±4.1 kg/m², p<0.001 versus controls 24.5±2.8 kg/m²). Metabolic comorbidities clustered differently: diabetes prevalence was 46.7% (14/30) in MASLD versus 40.0% (12/30) in AFLD (p=0.002 versus controls). Hypertension affected 53.3% (16/30) of patients with MASLD and 50.0% (15/30) of patients with AFLD (p=0.005). Dyslipidemia prevalence was comparable (AFLD 60.0% (18/30), MASLD 60.0% (18/30), p<0.001 versus controls). Patients with AFLD reported a mean alcohol consumption of 65.7±22.1 g/day. MASLD manifests earlier with dense metabolic clustering, while AFLD presents later with significant alcohol exposure. These distinct phenotypes suggest divergent pathogenic trajectories requiring tailored screening and management. The high metabolic burden in AFLD underscores overlapping etiologies and potential synergistic hepatotoxicity.

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