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《2024年国际酒精相关肝病专家小组立场声明：代谢功能障碍和酒精相关性肝病》解读
DOI: 10.12449/JCH250308
利益冲突声明：本文不存在任何利益冲突。
作者贡献声明：江臻遥、张彬彬负责撰写论文；李婕、施军平负责文章校审。
Interpretation of metabolic dysfunction and alcohol-related liver disease： Position statement by an expert panel on alcohol-related liver disease （2024 edition）
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摘要: 2024年11月，国际酒精相关肝病专家小组发布关于代谢功能障碍和酒精相关性肝病（MetALD）的立场声明。MetALD是脂肪性肝病中新的亚型，指合并有较大饮酒量的代谢功能障碍相关脂肪性肝病（MASLD）患者。该立场声明指出准确评估饮酒量的重要性，并建议使用标准化方法及酒精相关生物标志物量化饮酒量，并结合代谢风险因素进行综合诊断。同时，立场声明指出了饮酒模式对MetALD诊断的影响，并建议在患者分型时考虑其长期饮酒史。该声明还探讨了饮酒与代谢综合征、肝脂肪变性、肝纤维化及2型糖尿病之间的复杂关联，并提出通过结合肝组织学和非侵入性模型，优化患者的分层管理。声明重点阐述了MetALD的定义、饮酒评估、酒精使用与代谢障碍之间的相互作用以及如何综合管理MetALD，以方便临床医生与科研工作者学习和指导临床实践。
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关键词:
- 代谢功能障碍和酒精相关性肝病 /
- 诊断 /
- 治疗学 /
- 共识
Abstract: In November 2024， the Expert Group on Alcohol-related Liver Disease released a position statement on metabolic dysfunction and alcohol-related liver disease （MetALD）. MetALD is a new subtype of steatotic liver disease and refers to MASLD patients with a relatively large amount of alcohol consumption. The position statement points out the importance of accurate evaluation of alcohol consumption and recommends to quantify alcohol consumption using standard methods and alcohol biomarkers， and a comprehensive diagnosis should be made based on metabolic risk factors. In addition， the position statement analyzes the influence of drinking pattern on the diagnosis of MetALD and recommends to consider long-term drinking history during typing. The position statement also discusses the complex association between drinking and the diseases including metabolic syndrome， hepatic steatosis， fibrosis， and type 2 diabetes mellitus， and it is pointed out that the hierarchical management of patients should be optimized based on liver histological models and noninvasive models. The position statement elaborates on the definition of MetALD， drinking assessment， the interaction between alcohol use and metabolic dysfunction， and the methods for comprehensive management of MetALD， in order to facilitate learning and provide guidance for clinicians and researchers in clinical practice. -
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