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摘要：
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摘要：目的 探讨基于非酒精性脂肪性肝病（non-alcoholic fatty liver disease，
NAFLD）、代谢相关脂肪性肝病（metabolic dysfunction-associated fatty liver disease，
MAFLD）、代谢功能障碍相关脂肪变性肝病（metabolic dysfunction-associated steatotic
liver disease，MASLD）3种诊断标准下，肝纤维化程度与肾活检确诊的慢性肾脏病
（chronic kidney disease，CKD）人群临床指标和肾脏病理评分的相关性。方法 以2020年
7月10日至2023年5月5日于江南大学附属中心医院肾脏内科接受肾穿刺活检的CKD患
者为研究对象，收集其临床资料、实验室指标及病理数据；根据NAFLD、MAFLD、
MASLD的诊断标准进行分组（NAFLD组、非NAFLD组；MAFLD组、非MAFLD组；
MASLD组、非MASLD组）后比较非脂肪性肝病与脂肪性肝病人群的临床指标和肾脏
病理评分的差异，同时采用Spearman相关性分析各组人群脂肪肝纤维化评分（NAFLD
fibrosis score，NFS）与临床指标及病理评分的相关性。依据肾脏病理类型将脂肪性
肝病患者（NAFLD组、MAFLD组、MASLD组）分为原发性肾病（primary kidney
diseases，PKD）组和继发性肾病（secondary kidney diseases，SKD）组，再次分析
NFS与临床指标及病理评分的相关性，并通过Logistic回归分析肾脏疾病进展的危险因
素。结果 与非脂肪性肝病组相比，NAFLD/MAFLD/MASLD人群的体重指数及代谢性
疾病的患病率均更高（P均＜ 0.05），而血清肌酐、估算的肾小球滤过率（estimated
glomerular filtration rate，eGFR）和肾脏病理评分差异无统计学意义（P均＞ 0.05）。在
NAFLD/MAFLD/MASLD人群中，NFS与eGFR水平呈负相关（NAFLD：r = －0.329，
P = 0.001；MAFLD：r = －0.360，P ＜ 0.001；MASLD：r = －0.312，P = 0.001），
并与24小时尿蛋白、血尿素氮、肾小管萎缩评分呈正相关（P均＜ 0.05）。脂肪性肝
病合并PKD与SKD人群中NFS与eGFR均呈负相关，脂肪性肝病合并SKD人群中NFS
与肾小管萎缩评分呈正相关（P均＜ 0.05）；但进一步Logistic回归分析表明NFS仅是
脂肪性肝病合并SKD患者肾脏疾病进展的独立危险因素 [eGFR：NAFLD-OR = 4.436
（95%CI: 1.247～15.777），MAFLD-OR = 2.321（95%CI: 1.130～4.769），MASLDOR
= 2.767（95%CI: 1.065～7.192）；肾小管萎缩：NAFLD-OR = 10.08（95%CI:
1.258～80.76），MAFLD-OR = 2.394（95%CI: 1.020～5.617），MASLD-OR = 5.194
（95%CI: 1.140～23.662），P均＜ 0.05]。结论 NAFLD/MAFLD/MASLD 3种诊断标准
下，NFS均与eGFR降低和肾小管萎缩加重显著相关；尤其在体重-代谢失衡的脂肪性肝
病合并SKD亚组中，NFS是其肾脏疾病进展的独立危险因素。
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Abstract: Objective To investigate the correlation between liver fibrosis severity and clinical
parameters as well as kidney pathology scores in patients with chronic kidney disease (CKD)
confirmed by renal biopsy under three diagnostic criteria: non-alcoholic fatty liver disease
(NAFLD), metabolic dysfunction-associated fatty liver disease (MAFLD) and metabolic
dysfunction-associated steatotic liver disease (MASLD). Methods Patients with CKD who
underwent renal biopsy at the Department of Nephrology in Jiangnan University Medical
Center from July 10th, 2020 to May 5th, 2023 were enrolled. Clinical data, laboratory
parameters and pathological findings were collected. Patients were categorized based on
NAFLD, MAFLD and MASLD criteria (NAFLD group, non-NAFLD group; MAFLD
group, non-MAFLD group; MASLD group, non-MASLD group). Differences in clinical
indicators and kidney pathology scores between non-fatty liver group and fatty liver group
were compared. Spearman correlation analysis was used to assess the correlation between
NAFLD fibrosis score (NFS) and clinical/pathological parameters within each fatty liver
group. Patients were further stratified into primary kidney disease (PKD) and secondary
kidney disease (SKD) subgroups based on renal pathology for correlation analysis. Logistic
regression analysis was used to identify the risk factors for renal function progression within
subgroups. Results Compared with non-fatty liver group, NAFLD, MAFLD and MASLD
groups exhibited significantly higher body mass index (BMI) and prevalence of metabolic
diseases (all P ＜ 0.05). However, serum creatinine, estimated glomerular filtration rate
(eGFR) and kidney pathology scores showed no significant differences (all P ＞ 0.05). Within
NAFLD, MAFLD and MASLD groups, NFS was negatively correlated with eGFR (NAFLD:
r = －0.329, P = 0.001; MAFLD: r = －0.360, P ＜ 0.001; MASLD: r = －0.312, P = 0.001)
and positively correlated with 24-hour urinary protein, blood urea nitrogen and tubular atrophy
score (all P ＜ 0.05). Subgroup analysis revealed a negative correlation between NFS and
eGFR in both PKD and SKD subgroups with fatty liver (all P ＜ 0.05). NFS was positively
correlated with tubular atrophy score only in SKD subgroup with fatty liver (P ＜ 0.05). Logistic
regression analysis revealed NFS as an independent risk factor for renal function progression
(declining eGFR and worsening tubular atrophy), specifically in the SKD subgroup with fatty
liver [eGFR: NAFLD-OR = 4.436 (95%CI: 1.247～15.777), MAFLD-OR = 2.321 (95%CI:
1.130～4.769), MASLD-OR = 2.767 (95%CI: 1.065～7.192); tubular atrophy: NAFLD-OR = 10.08
(95%CI: 1.258～80.76), MAFLD-OR = 2.394 (95%CI: 1.020～5.617), MASLD-OR = 5.194
(95%CI: 1.140～23.662), all P ＜ 0.05]. Conclusions Under NAFLD, MAFLD and MASLD
diagnostic criteria, higher NFS is significantly associated with reduced eGFR and aggravated
tubular atrophy. Notably, NFS serves as an independent risk factor for renal function
progression specifically in the subgroup of patients with fatty liver and secondary kidney
disease characterized by weight-metabolic imbalance.
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