代谢功能障碍相关的脂肪性肝病、心血管和肾脏疾病：三重挑战

摘要(中文译文)

代谢功能障碍相关脂肪变性肝病（MASLD）越来越被认为是心血管-肾脏代谢（CKM）综合征的核心组成部分，反映了驱动多器官疾病的胰岛素抵抗、炎症和纤维化损伤的共同途径。MASLD影响全球超过三分之一的成年人，经常与慢性肾病（CKD）和心血管疾病（CVD）共存，并与肾功能下降、心血管事件和死亡率的较高风险有关。肝脂肪变性和纤维化可能会放大全身代谢应激和内皮功能障碍，导致进行性肾损伤和不良的心脏代谢结果。尽管存在这种生物学和流行病学上的重叠，但MASLD在肾脏病学和心脏病学实践中仍未得到充分认识。这一差距意味着错失了早期识别多器官并发症高危患者的机会。非侵入性肝纤维化评估，结合肾脏和心血管风险分层，为识别可能受益于强化预防策略的患者提供了一种实用的方法。生活方式的改变仍然是基础，而新兴的药物疗法，包括胰高血糖素样肽-1受体激动剂、钠葡萄糖共转运蛋白-2抑制剂、盐皮质激素受体拮抗剂和肝脏导向药物，都显示出潜在的跨器官益处。针对代谢功能障碍的协调管理可能会减缓肾脏疾病的进展，同时改善肝脏和心血管的预后。本综述强调了MASLD、CKD和CVD的临床交叉，并提出了筛查和管理的多学科框架。认识到MASLD是系统性CKM疾病的一部分可以为风险分层提供信息，指导治疗选择，并支持早期干预，以减轻肝脏、肾脏和心血管并发症的三重负担。

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as a central component of cardiovascular-kidney-metabolic (CKM) syndrome, reflecting shared pathways of insulin resistance, inflammation, and fibrotic injury that drive multi-organ disease. Affecting more than one-third of adults worldwide, MASLD frequently coexists with chronic kidney disease (CKD) and cardiovascular disease (CVD) and is associated with higher risks of kidney function decline, cardiovascular events, and mortality. Hepatic steatosis and fibrosis may amplify systemic metabolic stress and endothelial dysfunction, contributing to progressive kidney injury and adverse cardiometabolic outcomes. Despite this biologic and epidemiologic overlap, MASLD remains underrecognized in nephrology and cardiology practice. This gap represents a missed opportunity to identify patients at high risk of multi-organ complications early. Noninvasive liver fibrosis assessment, integrated with kidney and cardiovascular risk stratification, offers a practical approach to identifying patients who may benefit from intensified preventive strategies. Lifestyle modification remains foundational, while emerging pharmacotherapies, including glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors, mineralocorticoid receptor antagonists, and liver-directed agents, demonstrate potential cross-organ benefits. Coordinated management targeting metabolic dysfunction may slow the progression of kidney disease while improving hepatic and cardiovascular outcomes. This review highlights the clinical intersection of MASLD, CKD, and CVD and proposes a multidisciplinary framework for screening and management. Recognizing MASLD as part of systemic CKM disease can inform risk stratification, guide therapy selection, and support earlier intervention to mitigate the triple burden of liver, kidney, and cardiovascular complications.

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