非酒精性脂肪性肝病

预约门诊

生存率

代谢功能障碍相关脂肪变性肝病（MASLD）和代谢功能障碍相关脂肪性肝炎（MASH）是日益常见的肝脏状况，尤其是在患有肥胖症、糖尿病、高血压和高胆固醇的人群中。这些疾病过去被称为非酒精性脂肪性肝病（NAFLD）和非酒精性脂肪性肝炎（NASH），但专家更新了名称，以更好地反映它们与代谢健康的联系。

MASLD 是指肝脏脂肪过多。即使不饮酒，也可能发生这种情况。MASLD 常见于超重者或糖尿病患者。全世界超过三分之一的人群患有 MASLD。

MASH 是一种更严重形式的肝病。这意味着肝脏不仅有脂肪堆积，还有炎症和损伤。

存在哪种肝脏状况以及其他几个因素，是了解您的治疗前景（也称为预后）的关键。

了解 MASLD 和 MASH 结局

许多 MASLD 患者没有肝脏相关并发症，尤其是如果他们减轻了代谢风险因素。研究表明，MASLD 患者的平均寿命比没有这种状况的人短约三年。MASLD 会增加患心脏病和某些类型癌症的风险。高达 20% 到 30% 的 MASLD 患者可能会发生 MASH。

患有 MASH 时，炎症和损伤会随时间推移导致瘢痕形成（又称纤维化）、肝硬化（即严重瘢痕形成）和肝癌。这些状况对生存率有很大影响。

影响结局的因素

医务人员使用名为纤维化分期（从 F0 到 F4）的系统来衡量肝脏的受损程度。

F3 或 F4 纤维化患者发生肝衰竭和癌症的风险更高。平均 10 年生存率反映了这一点。

  • F0 至 F2：约 89% 至 93%。
  • F3：约 81%。
  • F4，也被称为肝硬化：约 51%，具体取决于并发症。

瘢痕形成加重为肝硬化的过程通常较为缓慢，需要数年到数十年。平均而言，MASH 患者大约每七年进入下一个纤维化阶段，而 MASLD 患者则为大约每 14 年。

有肝脏瘢痕形成但无重大并发症（称为代偿性肝硬化）的患者生存率高于有瘢痕形成且有重大并发症（称为失代偿性肝硬化）的患者。并发症包括腹腔积液（称为腹水）、胃肠道出血（又称静脉曲张出血）和意识模糊（称为肝性脑病）。对于失代偿性肝硬化患者，如果不接受肝移植，平均生存时间为 2 至 3 年。

影响预后的其他因素包括：

心脏健康。 心脏病是 MASLD 或 MASH 患者的首要死亡原因。这是因为这些肝脏状况通常伴有高血压、高胆固醇和糖尿病，所有这些情况都会损害心脏。

糖尿病和肥胖症。 患有糖尿病或超重会使肝脏健康状况加重。它还会增加出现肾脏问题和其他健康问题的风险。

年龄和出生指定性别。 老年人的肝损伤程度往往更严重。男性可能更容易出现严重的瘢痕形成，而女性肝脏中的脂肪可能更多，但在进入绝经期前进展缓慢。

生活方式。 饮酒、吃不太健康的食物和缺乏运动会使肝病加重。但健康的习惯可以减缓甚至逆转损害。

基因。 有些人的遗传特征使他们更容易出现肝损伤。研究人员仍在探索如何利用这些信息来帮助存在肝脏状况的患者。

好消息是，MASLD 和 MASH 通常可以通过改变生活方式来控制，有时甚至可以改善。例如，仅减轻 7% 至 10% 的体重就可以减少肝脏脂肪和炎症。采用含有大量水果、蔬菜、全谷物和健康脂肪的地中海饮食也可以改善肝脏健康。

申请预约
分期医生与科室
Oct. 15, 2025
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