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代谢相关脂肪性肝病是全球患病率最高的肝脏疾病之一。《柳叶刀-胃肠病学和肝脏病学》(The Lancet Gastroenterology & Hepatology发表了2023年全球疾病负担研究的系统性分析,评估了1990年至2023年代谢相关脂肪性肝病在全球、区域及国家层面的疾病负担,量化已明确可控风险因素的贡献,并预测至2050年的患病情况。研究发现,2023年全球约有13亿人患病,较1990年增长143%。据估计,截至2050年,患病人数将攀升至约18亿,主要由全球人口增长以及生活方式变化(如肥胖和高血糖)共同驱动。识别图中二维码或点击文末阅读原文,查阅原文。

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《柳叶刀-胃肠病学和肝脏病学》(The Lancet Gastroenterology & Hepatology发表的一项基于2023年全球疾病负担、伤害与风险因素研究(GBD)的分析显示,代谢相关脂肪性肝病(MASLD,既往称为非酒精性脂肪性肝病[NAFLD])仍是全球患病率最高且增长最快的肝脏疾病之一。研究发现,2023年全球约有13亿人患有MASLD,较1990年增长143%。据估计,截至2050年,MASLD的患病人数将攀升至约18亿,主要由全球人口增长以及生活方式变化(如肥胖和高血糖)共同驱动。

包括北非和中东在内的一些地区MASLD患病率明显高于其他地区。研究还发现,尽管患病人数不断增加,但以疾病或死亡所致寿命损失年衡量的总体健康负担仍保持稳定。这提示治疗和照护方面的进步正在帮助患者获得更长且更健康的寿命,且增加的病例大多处于疾病早期阶段。然而,病例数量的持续增长仍意味着未来将有大量人群面临肝硬化或癌症等严重并发症的风险。

作者指出,这些研究结果表明,在城市化和生活方式改变的背景下,MASLD正日益影响着中低收入国家的年轻成人。这些发现强调,应将MASLD视为全球健康优先事项,制定专门政策、开展宣传活动并采取干预措施,以减轻其日益增长的影响并预防未来并发症的发生。

文章摘要


1990-2023年代谢相关脂肪性肝病的全球负担及至2050年的预测:2023年全球疾病负担研究的系统性分析

背景



代谢相关脂肪性肝病是全球患病率最高的肝脏疾病之一,带来经济和健康的双重挑战。本研究旨在评估1990年至2023年MASLD在全球、区域及国家层面的疾病负担,量化已明确可控风险因素的贡献,并预测至2050年的患病情况。


方法


作为2023年全球疾病负担、伤害和风险因素研究(GBD)的一部分,本研究对1990年至2023年间204个国家和地区按年龄、性别、地区、社会人口学指数(SDI)以及医疗可及性与质量指数(HAQ)分层的MASLD患病情况和伤残调整寿命年(DALYs)进行了估计。作为GBD比较风险评估的一部分,本研究评估了可归因于三种风险因素(吸烟、高体重指数[BMI]和高空腹血糖)的MASLD负担。在二次分析中,本研究利用以上估计值,以空腹血糖和平均BMI为预测因子,估计至2050年的MASLD患病情况。此外,为了评估人口老龄化、人口增长以及MASLD患病率变化在2023年至2050年预测病例数中的相对贡献,本研究还进行了分解分析。


结果


据估计,2023年全球约有13亿人(95%不确定区间[UI]:12-14)患有MASLD(占全球人口的16.1%),MASLD的年龄标准化患病率为每10万人14429.3例(13268.3-15990.6)。与1990年相比,2023年粗患病人数增加142.7%(139.2-146.7,1990年为5亿[5-6]),患病率上升28.6%(27.8-29.5,1990年为每10万人11217.2例[10276.8-12467.0])。2023年,全球约有360万(280-450)DALYs归因于MASLD,对应的年龄标准化DALY率为每10万人39.6(31.2-49.9)。尽管粗DALYs较1990年(170万[130-210])增加116.3%(93.3-139.4),但其年龄标准化估计值在1990年至2023年间保持稳定(1.8%[-8.6至12.8],1990年为每10万人38.9[30.1-49.8])。不同地区的年龄标准化估计值存在显著差异。北非和中东地区的患病率最高(每10万人29246.1例[26848.3-32048.7]),安第斯拉丁美洲的DALY率最高(每10万人152.3[114.1-194.7])。相比之下,高收入亚太地区的患病率最低(每10万人8653.5例[7923.7-9592.8]),东亚地区的DALY率最低(每10万人16.3[13.5-19.9])。在SDI相近的地区中,北非和中东的患病率更高。较低的SDI和HAQ与较高的年龄标准化DALY率相关。


男性的年龄标准化患病率始终高于女性(2023年男性为每10万人15616.4例[14349.2-17263.3],女性为每10万人13245.2例[12132.0-14692.6]),且男女均在80-84岁达到峰值。MASLD患病人数在年轻成人中最多,其中男性在35-39岁达到峰值,女性在55-59岁达到峰值。在MASLD的风险因素中,2023年高空腹血糖对总MASLD年龄标准化DALY率的贡献最大(每10万人2.2[1.6-3.1]),其次为高BMI(每10万人1.4[0.6-2.4])和吸烟(每10万人1.0[0.3-1.8])。预测模型估计,截至2050年将有18亿人(16-20)患有MASLD,较2023年增加42.0%。据估计,2050年年龄标准化患病率将上升至每10万人15774.9例(14613.9-17336.2),对应的平均年度变化百分比为0.3%(0.3-0.3)。分解分析显示,这一变化将主要归因于人口增长,尤其是在撒哈拉以南非洲、北非和中东地区,而人口老龄化和流行病学变化的贡献相对较小。


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图2 2023年按年龄组和性别划分的代谢相关脂肪性肝病患病率及伤残调整寿命年

解释


2023年,全球约有13亿人患MASLD,全球患病率为16.1%,该疾病已经并将持续在全球范围内对健康和经济产生重大影响。HAQ指数与年龄标准化DALY率之间呈负相关,提示医疗服务可及性和质量较低的国家在应对日益增长的MASLD负担方面可能处于更不利的地位,这凸显了在这些地区加强卫生系统能力建设的必要性。END


Funding

Gates Foundation.

Declaration of interests

M Carvalho reports other financial or non-financial support from LAQV/REQUIMTE, University of Porto, Porto, Portugal and FCT/MCTES under the scope of the project UIDP/50006/2020 (DOI:10.54499/UIDP/50006/2020) outside the submitted work. S Congly reports grants or contracts paid to his institution from AstraZeneca, Merck, Ipsen, Bausch Health, Oncoustics, and Boehringer Ingelheim; grants or contracts from Gilead Sciences Canada; consulting fees from Boehringer Ingelheim and GSK; participation on a data safety monitoring board or advisory board with AstraZeneca, Gilead Sciences Canada, and Boehringer Ingelheim; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Canadian Association for the Study of the Liver on the Board of Directors, Alberta Medical Association on the Representative Forum, and Alberta Gastroenterology Society as President; all outside the submitted work. I M Ilic reports support for the submitted work from the Ministry of Science, Technological Development and Innovation of the Republic of Serbia (grant 451-03-137/2025-03/200110). N E Ismail reports leadership or fiduciary roles in board, society, committee or advocacy groups, unpaid, with the Malaysian Academy of Pharmacy, Malaysia as Bursar and Council Member, Malaysian Pharmacists Society Education Chapter Committee as Committee Member, and Information Technology Service Management Forum (itSMF) Malaysia Chapter as Deputy President; all outside the submitted work. J J Jozwiak reports payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing or educational events from Novartis, Adamed, Amgen, Boehringer Ingelheim, Servier, and Novo Nordisk outside the submitted work. K Krishan reports non-financial support from the UGC Centre of Advanced Study, CAS II, awarded to the Department of Anthropology, and RUSA 2.O grant awarded to Panjab University, Chandigarh, India, outside the submitted work. M-C Li reports grants or contracts from the National Science and Technology Council, Taiwan (NSTC 113-2314-B-003-002) and the “Higher Education Sprout Project” of National Taiwan Normal University; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the Journal of the American Heart Association as Technical Editor; all outside the submitted work. S Lorkowski reports grants or contracts from dsm-firmenich (formerly DSM Nutritional Products) paid to his institution; consulting fees from Danone, Novartis Pharma, and Swedish Orphan Biovitrum (SOBI); payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from AMARIN Germany, Amedes Holding, AMGEN, AstraZeneca, Berlin-Chemie, Boehringer Ingelheim Pharma, Daiichi Sankyo Deutschland, Danone, Hubert Burda Media Holding, Janssen-Cilag, Lilly Deutschland, Novartis Pharma, Novo Nordisk Pharma, Roche Pharma, Sanofi-Aventis, Swedish Orphan Biovitrum (SOBI), and SYNLAB Holding Deutschland; support for attending meetings or travel, or both, from Amgen; participation on a data safety monitoring board or advisory board with Amgen, Daiichi Sankyo Deutschland, Novartis Pharma Sanofi-Aventis; all outside the submitted work. E Lytvyak reports grants or contracts and consulting fees from Novo Nordisk; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from CPD Network and Novo Nordisk; all outside the submitted work. W März reports consulting fees from Amgen, Sanofi, Amryt Pharmaceuticals, Abbott Diagnostics, Akzea Therapeutics, Novartis Pharma, and SOBI; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Amgen, Sanofi, Amryt Pharmaceuticals, Abbott Diagnostics, Akzea Therapeutics, Novartis Pharma, and SOBI; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with DACH Society Prevention of Cardiovascular Disease as a Board Member; and other financial or non-financial support from SYNLAB Holding Deutschland; all outside the submitted work. P C Matthews reports support for the present manuscript from Francis Crick Institute (ref CC2223), and University College London NIHR Biomedical Research Centre; outside the submitted work: royalties or licenses from Oxford University Press; honoraria for delivery of educational materials from Johnson & Johnson; and leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with UK National Strategic Group for Viral Hepatitis (NSGVH) as Co-chair. B Oancea reports support for the present manuscript from the Romanian National Research, Development, and Innovation Plan 2022–27, project PNRR/2022/C9/MCID/I8 number 1672173292, contract number 760231. B M Schaarschmidt reports grants or contracts from Else Kröner-Fresenius Foundation, Deutsche Forschungsgemeinschaft, and PharmaCept; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from AstraZeneca, Boston Scientific, and MedMile; support for travel from Bayer; all outside the submitted work. J I Shin reports other financial or non-financial support from the Yonsei Fellowship, funded by Lee Youn Jae, outside the submitted work. D Trico reports payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from AstraZeneca, Eli Lilly, and Novo Nordisk; support for attending meetings or travel, or both, from AstraZeneca; participation on a data safety monitoring board or advisory board with Amarin, Boehringer Ingelheim, and Novo Nordisk; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with European Association for the Study of Diabetes (EASD) Early Career Academy and EASD Committee on Clinical Affairs; receipt of equipment, materials, drugs, medical writing, gifts or other services from Abbott and PharmaNutra; all outside the submitted work. M Zielińska reports other financial or non-financial support as an Alexion, AstraZeneca Rare Disease employee, outside the submitted work. All other authors declare no competing interests. The corresponding author takes responsibility for the accuracy and completeness of these declarations.



中文翻译仅供参考,所有内容以英文原文为准。
题图Copyright: GettyImages/PonyWang 
DOI: 10.1016/S2468-1253(26)00011-7 


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