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2026年欧洲肝病学会年会（EASL 2026）于2026年5月27日-30日在西班牙•巴塞罗那顺利召开。作为全球肝病学领域的学术盛会，本届大会汇聚国际顶尖专家学者，共同探讨肝病学、胃肠病学、移植外科及传染病学等领域的最新研究进展与临床实践突破。

大会设置前沿学术报告、高互动性研讨会及专题论坛，为与会者提供深度交流与专业提升的高端平台。为及时传递大会精华内容，肝胆相照平台全程跟踪报道，本篇精选MASLD领域热点研究进行整理，以传递大会的最新动态和精彩看点。

01 TOP-162

胰高血糖素样肽-1受体激动剂对代谢相关脂肪性肝病合并2型糖尿病患者远期肝脏结局的影响：一项大型真实世界研究分析

Glucagon-like peptide-1 receptor agonists and long-term liver outcomes in metabolic dysfunction-associated steatotic liver disease and type 2 diabetes: a large real-world analysis

作者：Arunkumar Krishnan, Diptasree Mukherjee, Carolin V Schneider, Saleh A. Alqahtani

研究背景与目的▼

代谢相关脂肪性肝病（MASLD）目前已成为全球最常见的慢性肝病，该疾病常与2型糖尿病（T2D）合并存在，会使患者发生肝硬化及肝细胞癌（HCC）的风险数倍升高，合并晚期肝纤维化者风险尤为显著。本研究基于大型真实世界队列，探讨胰高血糖素样肽-1受体激动剂（GLP-1RAs）治疗是否可降低代谢相关脂肪性肝病合并2型糖尿病成人患者罹患肝硬化与肝细胞癌的风险。

Background and aims：Metabolic dysfunction-associated steatotic liver disease (MASLD) is now the most common chronic liver disease globally and frequently coexists with type 2 diabetes (T2D), conferring a several-fold increased risk of cirrhosis and hepatocellular carcinoma (HCC), particularly in those with advanced fibrosis. This study examined whether treatment with glucagon-like peptide-1 receptor agonists (GLP-1RAs) is associated with reduced risks of cirrhosis and HCC in adults with MASLD and T2D in a large real-world cohort.

研究方法▼

本研究为回顾性多中心队列研究，依托TriNetX联合电子健康档案平台开展。纳入基线无肝硬化及肝细胞癌病史、确诊代谢相关脂肪性肝病合并2型糖尿病的成年患者。将持续用药至少6个月定义为暴露于胰高血糖素样肽-1受体激动剂，用药组以首次用药日期为时间起点，未用药组采用匹配对照日期。排除既往患有肝硬化、肝细胞癌、重度酒精使用障碍及其他慢性肝病的受试者。采用倾向性评分匹配对两组人群的人口学资料、体重指数、吸烟状态、糖化血红蛋白、心血管疾病患病情况及无创肝纤维化指标进行均衡。通过Cox比例风险模型计算肝硬化、肝细胞癌新发事件的校正风险比（aHR）及95%置信区间（CI）。

Method：A retrospective, multicenter cohort study was conducted using the TriNetX federated electronic health record platform. Adults with MASLD and T2D without prior cirrhosis or HCC at baseline were included. GLP-1RA exposure was defined as continuous treatment for at least 6 months, with time zero at the date of GLP-1RA initiation or a matched index date for non-users. Individuals with pre-existing cirrhosis, HCC, significant alcohol use disorder, or other chronic liver diseases were excluded. Propensity score matching was used to balance demographics, body mass index, smoking status, glycated hemoglobin, cardiovascular disease, and non-invasive fibrosis markers. Cox proportional hazards models estimated adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for incident cirrhosis and HCC.

研究结果▼

经匹配后研究队列共纳入52600名受试者，其中19200人使用胰高血糖素样肽-1受体激动剂，中位随访时长2730天。随访期间，共760例受试者新发肝硬化，165例新发肝细胞癌。用药组肝硬化发生率为2.4%，未用药组为3.5%，校正风险比为0.72，95%置信区间0.61~0.84；两组肝细胞癌发生率分别为0.5%和0.9%，校正风险比为0.66，95%置信区间0.45~0.96。基线肝纤维化风险越高的患者，风险下降幅度越明显，这与既往代谢相关脂肪性肝病队列研究结论相符，即早期使用该类药物可延缓肝纤维化进展，减少严重肝脏不良事件的发生。

Results：The matched cohort comprised 52,600 adults, of whom 19,200 received GLP-1RAs, with a median follow-up of 2,730 days. During follow-up, 760 participants developed cirrhosis and 165 developed HCC. Cirrhosis occurred in 2.4% of GLP-1RA users versus 3.5% of nonusers (aHR 0.72, 95% CI 0.61–0.84), while HCC occurred in 0.5% versus 0.9%, respectively (aHR 0.66, 95% CI 0.45–0.96). Relative risk reductions were greatest among patients with higher baseline fibrosis risk, consistent with prior MASLD cohorts in which earlier GLP-1RA use was linked to slower fibrosis progression and fewer major adverse liver outcomes.

研究结论▼

在这项大型真实世界研究中，对于代谢相关脂肪性肝病合并2型糖尿病的人群，使用胰高血糖素样肽-1受体激动剂可显著降低新发肝硬化与肝细胞癌的风险，基线肝纤维化风险偏高的患者获益更为突出。

Conclusion: In this large, real-world population with MASLD and T2D, GLP-1RA therapy was associated with substantially lower risks of incident cirrhosis and HCC, particularly in individuals with elevated baseline fibrosis risk.

02 FRI-141

瑞司美替罗用于合并中晚期肝纤维化的代谢相关脂肪性肝炎成人患者：早期真实世界疗效研究

Early real-world effectiveness of resmetirom in adults with metabolic dysfunction associated steatohepatitis and moderate-to-advanced fibrosis

作者：Naim Alkhouri, Yestle Kim, Karissa Johnston, John O’Donnell, Reem Mustafa, Yael Silberberg, Karin Keren, Rajagopal Chadalavada, Pradeep Bekal, Romina Fakhraei

研究背景与目的▼

瑞司美替罗（商品名Rezdiffra™）是一种甲状腺激素β受体激动剂，于2024年在美国附条件获批，用于治疗非肝硬化、合并中晚期肝纤维化的代谢相关脂肪性肝炎（MASH）成人患者。本研究基于美国消化科临床实践数据，分析瑞司美替罗的真实世界疗效，重点观察血液生物标志物及临床指标的变化。

Background and aims：Resmetirom (Rezdiffra™), a thyroid hormone receptor-beta agonist, was conditionally approved in the US in 2024 for adults with noncirrhotic MASH and moderate-to-advanced fibrosis. This study described real-world effectiveness of resmetirom in a US gastroenterology practice, focusing on changes in blood biomarkers and clinical measures.

研究方法▼

依托拉蒂卡真实世界数据库开展单臂回顾性队列研究。纳入2024年4月至2025年间至少开具过1次瑞司美替罗处方、且随访时长不少于6个月的成年患者，处方首日设为研究起始时间；排除起始时间前2年内罹患终末期肝病的患者。收集患者起始前12个月的基线人口学资料、合并症、合并用药及实验室检查数据，包括谷草转氨酶（AST）、丙氨酸氨基转移酶（ALT）、血小板、瞬时弹性成像联合转氨酶（FAST）评分、受控衰减参数瞬时弹性检测肝脏硬度值（LSM），并在随访期对上述指标进行复查。同时记录治疗相关不良事件及因不良事件停药的情况。

Method：A single-arm, retrospective cohort study using Latica real-world data repository was conducted. Adults with ≥1 resmetirom prescription (Apr 2024–2025; index date = first prescription) and ≥6 months of follow-up were included; those with end-stage liver disease in the 2 years pre-index were excluded. Baseline (12 months pre-index) demographics, comorbidities, concomitant medications, and laboratory measurements (AST, ALT, platelets, FibroScan AST [FAST] score, Vibration-Controlled Transient Elastography Liver Stiffness Measurement [LSM]) were captured and, when available, reassessed during follow-up. Treatment-related adverse events (AEs) and AE-related discontinuations were recorded.

研究结果▼

共计1278名瑞司美替罗用药者中，712例（55.7%）符合入组标准。患者平均用药时长为5.7±4.1个月。约80%患者存在至少两项心血管代谢危险因素，其中高血压（77%）和肥胖（71%）最为常见。在基线与随访数据完整的患者中，FAST评分平均下降0.18（28例），丙氨酸氨基转移酶平均下降13.6 U/L（330例），肝脏硬度值平均下降2.2 kPa（70例）。按疗效判定标准，FAST评分降幅≥0.22的应答率为42.9%；丙氨酸氨基转移酶降幅≥17 U/L或下降比例≥20%的应答率为46.7%；肝脏硬度值降幅≥30%的应答率为41.4%。

无论患者是否联用他汀类药物（联用组232例、未联用组480例），各项指标变化趋势相近，两组血脂指标均得到改善：低密度脂蛋白胆固醇分别下降19.3 mg/dL、10.3 mg/dL，总胆固醇分别下降16.9 mg/dL、1.2 mg/dL；谷草转氨酶均出现下降，降幅分别为8.7 U/L、3.4 U/L；丙氨酸氨基转移酶变化存在差异，联用组升高4.0 U/L，未联用组下降3.8 U/L。

对比联用胰高血糖素样肽-1受体激动剂组（139例）与未联用组（573例）：两组谷草转氨酶、丙氨酸氨基转移酶降幅相近（约-8 U/L、-14 U/L），身体质量指数均小幅下降（约-1 kg/m²）；未联用组FIB-4指数降幅略大（-0.1 vs -0.5），联用组肝脏硬度值下降更显著（-3.2 kPa vs -1.9 kPa）；两组受控衰减参数均明显降低，分别为-39.5 dB/m、-43.9 dB/m。

因治疗相关不良事件停药的情况少见，发生率约2%，不良反应以腹泻为主。

Results：Of 1,278 resmetirom users, 712 (55.7%) met inclusion. Mean (SD) treatment duration was 5.7 (4.1) months. About 80% had ≥2 cardiometabolic risk factors, most often hypertension (77%) and obesity (71%). In patients with both baseline and follow-up values, mean FAST declined by 0.18 (n = 28), ALT by 13.6 U/L (n = 330), and LSM by 2.2 kPa (n = 70). Response thresholds were met in 42.9% for FAST (≥0.22 reduction), 46.7% for ALT (≥17 U/L or ≥20% reduction), and 41.4% for VCTE (≥30% reduction). Trends were similar across statin (n = 232) and non-statin users (n = 480); both improved in lipid markers [LDL (−19.3 vs −10.3) and total cholesterol (−16.9 vs −1.2 mg/dL)]. AST fell in both groups (−8.7 vs −3.4 U/L) and ALT changed in opposite directions (+4.0 vs −3.8 U/L). In GLP-1 concomitant users (n = 139) vs without (n = 573), ALT/AST declines were similar (∼−14/−8 U/L in both), BMI changed slightly (∼−1 kg/m2 in both), FIB-4 fell slightly more without GLP-1 (−0.1 vs −0.5), LSM declined more with GLP-1 (−3.2 vs −1.9 kPa), and CAP declined in both groups (−39.5 dB/m vs −43.9 dB/m). Discontinuation for treatment-related AEs was rare (∼2%), mostly due to diarrhea.

研究结论▼

该项真实世界研究显示，患者使用瑞司美替罗约6个月后，血液学及影像学相关生物标志物均出现具有临床意义的改善，其起效早于为期52周的MAESTRO-NASH临床试验结果。后续仍需扩大样本量、延长随访时间，进一步评估药物的远期疗效。

Conclusion:  In this real-world analysis, resmetirom was associated with clinically meaningful improvements in blood and imaging biomarkers over ∼6 months, suggesting earlier effectiveness than in the 52-week MAESTRO-NASH trial. Larger cohorts with longer follow-up are needed to assess long-term outcomes.

03 FRI-151

代谢相关脂肪性肝炎真实临床实践：优先选用胰高血糖素样肽-1受体激动剂还是瑞司美替罗

Which comes first: GLP-1 RA vs resmetirom in MASH real world practice

作者：Ana Maria Davila Morales, Amanda Rodriguez, Nancy S. Reau, Phoebe Lebeau

研究背景与目的▼

代谢相关脂肪性肝病（MASLD）是一类疾病谱，从单纯肝脂肪变性逐步进展至代谢相关脂肪性肝炎（MASH）。该疾病常合并肥胖、血脂异常、糖尿病、高血压等代谢性疾病。目前相关诊疗指南尚未明确两种药物的使用先后顺序，以及联用时机。瑞司美替罗适用于非肝硬化、合并中重度肝纤维化的患者。由于此类人群肥胖与糖尿病患病率较高，很多患者会同时使用胰高血糖素样肽-1受体激动剂（GLP-1受体激动剂）。后者可用于代谢相关脂肪性肝病患者，其调脂作用能使血脂异常及心血管疾病患者获益，而瑞司美替罗同样具备调脂效果。针对合并多种代谢危险因素的患者个体化选用上述药物，有望提升治疗获益。本研究旨在分析代谢相关脂肪性肝炎的真实临床用药方案。

Background and aims：Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is a spectrum of liver diseases ranging from steatosis to metabolic dysfunction-associated steatohepatitis (MASH). MASLD is associated with metabolic diseases such as obesity, hyperlipidemia, diabetes and hypertension. MASLD guidelines have not outlined which medication to start first and when to add a second agent. Resmetirom is used in patients with moderate to severe fibrosis without cirrhosis. Given the high prevalence of obesity and diabetes in this population, many are also treated with glucagon-like peptide-1 receptor agonists (GLP-1 RAs). These are indicated in patients with MASLD and those with dyslipidemia and cardiovascular disease may benefit from lipid-lowering effects, which is also a positive effect from resmetirom. Tailoring these medications in patients with multiple metabolic risk factors may prove beneficial. This study aims to provide insight into real-world treatment practices for the treatment of MASH.

研究方法▼

依托Slicer Dicer数据平台，在一家学术型医疗中心开展回顾性研究，研究对象为正在使用瑞司美替罗治疗、非肝硬化且合并中晚期肝纤维化的代谢相关脂肪性肝炎患者，统计患者联用GLP-1受体激动剂的情况。收集数据包括身体质量指数，以及肥胖、血脂异常、高血压、糖尿病等代谢危险因素。

Method：A retrospective study of patients currently on resmetirom for treatment of MASH with moderate to advanced liver fibrosis without cirrhosis at an academic medical center was conducted using Slicer Dicer. Concurrent use of GLP-1 RA medication was recorded. Data included BMI (body mass index) and presence of metabolic risk factors including obesity, dyslipidemia, hypertension and diabetes.

研究结果▼

共纳入30例正在使用瑞司美替罗的患者，其中15例（50%）同时联用GLP-1受体激动剂。单药治疗组中，无代谢危险因素者1例（6.6%），存在1项危险因素者3例（20%），存在2项危险因素者7例（46.6%），存在3项危险因素者3例（20%），存在4项危险因素者1例（6.6%）。双联用药组中，无患者存在0项或1项代谢危险因素；存在2项危险因素者1例（6.6%），存在3项危险因素者10例（66.6%），存在4项危险因素者4例（26.6%）。

Results：30 patients currently on resmetirom were identified. Of these, 50% were concurrently on a GLP-1 RA medication (n = 15). Of patients on single-agent treatment, one patient had 0 metabolic risk factors (6.6%), three had 1 risk factor (20%), seven had 2 risk factors (46.6%), three had 3 risk factors (20%), and one had 4 risk factors (6.6%). Of patients on dual-agent treatment, no patients had 0 or 1 metabolic risk factors, one patient had 2 risk factors (6.6%), ten had 3 risk factors (66.6%), and four patients had 4 risk factors (26.6%).

研究结论▼

本研究显示，合并3项及以上代谢危险因素的代谢相关脂肪性肝炎患者，更倾向于采用瑞司美替罗联合GLP-1受体激动剂的双联方案，而非单药治疗。该用药思路可同时干预肝脏炎症、肝纤维化以及基础代谢危险因素。晚期代谢相关脂肪性肝炎患者普遍合并多项危险因素，仍需开展更多研究，进一步对比双联疗法与单药疗法的疗效与应用价值。

Conclusion: This study demonstrates that patients with MASH and 3 or more metabolic risk factors were more likely to be started on dual-agent therapy with resmetirom and GLP-1 RA compared to single-agent. This is the result of an approach targeted to address inflammation and fibrosis of the liver while also addressing underlying risk factors. The high prevalence of multiple risk factors present in patients with advanced MASH highlights the need for further studies to determine the effectiveness and benefits of dual-agent therapy compared to single-agent therapy.

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