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肾脏病与透析肾移植杂志 ›› 2026, Vol. 35 ›› Issue (2): 159-163.DOI: 10.3969/j.issn.1006-298X.2026.02.012

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代谢功能障碍相关脂肪性肝炎:从 NASH 到 MASH

  

  • 出版日期:2026-04-28 发布日期:2026-04-23

Metabolic dysfunction⁃associated steatohepatitis:from NASH to MASH

  • Online:2026-04-28 Published:2026-04-23

摘要: 代谢功能障碍相关脂肪性肝病 (MAFLD) 和代谢功能障碍相关脂肪性肝炎 (MASH) 通过复杂的病理生理机制与心血管系统、肾脏等产生内在联系,其中代谢因素是 MAFLD/MASH 和慢性肾脏病 (CKD) 间最关键的共同基础,而多种基因的多态性及肠⁃肝⁃肾轴在疾病的发生、发展中也发挥重要作用。MASH 和心血管⁃肾脏⁃代谢 (CKM) 综合征关系紧密。在 CKM 综合征的背景下,需要通过多学科的协作,为患者制定个性化饮食及运动方案,科学使用肾素⁃血管紧张素系统抑制剂、钠⁃葡萄糖协同转运蛋白 2 抑制剂、胰高血糖素样肽 1 受体激动剂和非奈利酮等药物,减轻肝脏的炎症,并改善患者的心肾功能。

关键词: 代谢功能障碍相关脂肪性肝炎, 慢性肾脏病, 心血管?肾脏?代谢综合征, 多学科合作

Abstract: Metabolic dysfunction associated fatty liver disease (MAFLD) and metabolic dysfunction associated steatohepatitis (MASH) are intrinsically linked to the cardiovascular system,kidney,and other organs through complex pathophysiological mechanisms.Metabolic abnormalities constitute the most pivotal common basis between MAFLD/MASH and chronic kidney disease (CKD),while the polymorphisms of multiple genes and the gut⁃liver⁃kidney axis also play important roles in disease initiation and progression.MASH is closely linked to the cardiovascular⁃kidney⁃metabolic (CKM) syndrome.In this context,multidisciplinary teamwork is required to design individualized diet and exercise plans,and to use renin⁃angiotensin system inhibitors (RASi),sodium⁃glucose cotransporter⁃2 inhibitors (SGLT2i),glucagon⁃like peptide⁃1 receptor agonists (GLP⁃1RA),and finerenone in an evidence⁃based manner,thereby reducing hepatic inflammation and improving both cardiac and renal function.