Doença hepática esteatótica associada à disfunção metabólica: o papel da ultrassonografia
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Jan 21, 2025
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Objetivo: analisar a doença hepática esteatótica associada à disfunção metabólica e sua relação com achados ultrassonográficos. Revisão Bibliográfica: A doença hepática gordurosa associada à disfunção metabólica (MASLD) é um novo termo que reflete a ligação dessa enfermidade com fatores de risco metabólicos, como obesidade e diabetes. Métodos não invasivos, como ultrassonografia e elastografia, estão substituindo a biópsia hepática em seu diagnóstico, acompanhamento e estratificação. A ultrassonografia permanece como o principal método de imagem para rastreio da MASLD, possibilitando graduar subjetivamente a esteatose em três níveis: grau 1 (leve), grau 2 (moderado), e grau 3 (acentuado). Os métodos de elastografia, seja a transitória (FibroScan), por ondas de cisalhamento (p-SWE e 2D-SWE) ou por ressonância magnética, medem a rigidez hepática permitindo identificação e estratificação da fibrose. Dentre eles, a elastografia por ressonância magnética é a de maior acurácia. Considerações finais: Tendo em vista o crescimento e repercussões da MASLD, o rastreio precoce de pacientes em risco e a estratificação da doença para manejo adequado são importantes para se evitar evoluções desfavoráveis, como fibrose significativa e avançada. A ultrassonografia, em particular, é essencial no rastreio da MASLD, enquanto a elastografia tem papel de destaque na estratificação da fibrose hepática.
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Como Citar
CostaD. D., & MalveiraC. T. M. (2025). Doença hepática esteatótica associada à disfunção metabólica: o papel da ultrassonografia. Revista Eletrônica Acervo Saúde, 25, e18250. https://doi.org/10.25248/reas.e18250.2025
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Revisão Bibliográfica
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Referências
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21. PARK CC, et al. Magnetic resonance elastography vs transient elastography in detection of fibrosis and noninvasive measurement of steatosis in patients with biopsy-proven nonalcoholic fatty liver disease. Gastroenterology, 2017; 152(3): 598–607. doi: 10.1053/j.gastro.2016.10.026.
22. PETTA S, et al. Monitoring occurrence of liver-related events and survival by transient elastography in patients with nonalcoholic fatty liver disease and compensated advanced chronic liver disease. Clin Gastroenterol Hepatol., 2021; 19(4): 806–15. doi: 10.1016/j.cgh.2020.06.045.
23. PISCAGLIA F, et al. The role of ultrasound elastographic techniques in chronic liver disease: current status and future perspectives. Eur J Radiol., 2014; 83(3): 450-5. doi: 10.1016/j.ejrad.2013.06.009.
24. RINELLA ME, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology, 2023; 78(6): 1966-86. doi: 10.1097/HEP.0000000000000520.
25. SAADEH S, et al. The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology, 2002; 123(3): 745-50. doi: 10.1053/gast.2002.35354.
26. SEMMLER G, et al. Diet and exercise in NAFLD/NASH: beyond the obvious. Liver Int., 2021; 41(10): 2249–68. doi: 10.1111/liv.15024.
27. SILVA DR, et al. Síndrome metabólica: seus riscos e malefícios para a saúde. Revista Eletrônica Acervo Saúde, 2024; 24(2): e15138.
28. SILVA LCM, et al. Ultrasound elastography in patients with fatty liver disease. Radiol Bras., 2020; 53(1): 47–55. Doi: 10.1590/0100-3984.2019.0028
29. SONG BG, et al. Metabolic dysfunction-associated fatty liver disease and the risk of hepatocellular carcinoma. JHEP Rep., 2023; 5(9): 100810. doi: 10.1016/j.jhepr.2023.100810.
30. TAPPER EB, et al. Simple non-invasive biomarkers of advanced fibrosis in the evaluation of non-alcoholic fatty liver disease. Gastroenterology Report., 2014; 2(4): 276-80. doi: 10.1093/gastro/gou034.
31. VESA CM, et al. Molecular Mechanisms of Metabolic Syndrome. Int J Mol Sci., 2024; 25(10): 5452. doi: 10.3390/ijms25105452
32. VILAR-GOMEZ E, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology, 2015; 149(2): 367–78. doi: 10.1053/j.gastro.2015.04.005.
33. WEIB J, et al. Non-alcoholic fatty liver disease— epidemiology, clincal course, investigation and treatment. Dtsch Arztebl Int., 2014; 111: 447–52.
34. YONEDA M, et al. Nonalcoholic fatty liver disease: US-based acoustic radiation force impulse elastography. Radiology, 2010; 256: 640-7.
35. YUE H e YIN l. Relationship between living habits and metabolic diseases in community populations based on ultrasound diagnosis of nafld. Rev bras med esporte, 2021; 27(spe): 37–9. doi: 10.1590/1517-8692202127012020_0094.
36. ZHANG X, et al. Excess body weight: Novel insights into its roles in obesity comorbidities. Semin Cancer Biol., 2023; 92: 16-27. doi:10.1016/j.semcancer.2023.03.00.
2. ANWAR SD, et al. Lipid Disorders and Metabolic-Associated Fatty Liver Disease. Endocrinol Metab Clin North Am., 2023; 52(3): 445-57. doi: 10.1016/j.ecl.2023.01.003
3. BRASIL. Vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico - VIGITEL. 2020. Ministério da Saúde, Secretária de Vigilância em Saúde. Disponível em: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/svsa/vigitel/relatorio-vigitel-2020-original.pdf/view.
4. CHEN YP, et al. A systematic review and a dose-response meta-analysis of coffee dose and nonalcoholic fatty liver disease. Clin Nutr., 2019; 38(6): 2552–7. doi: 10.1016/j.clnu.2018.11.030.
5. CRUZ JF, et al. Relação entre a esteatose hepática não alcoólica e as alterações dos componentes da síndrome metabólica e resistência à insulina. Rev. Soc. Bras. Clin. Med., 2016; 14(2): 79-83.
6. ESLAM M, et al. The Asian Pacific Association for the Study of the Liver clinical practice guidelines for the diagnosis and management of metabolic associated fatty liver disease. Hepatol Int., 2020; 14(6): 889–919. doi: 10.1007/s12072-020-10094-2.
7. FOUDA S, et al. Pathobiology of Metabolic-Associated Fatty Liver Disease. Endocrinol Metab Clin North Am., 2023; 52(3): 405-16. doi: 10.1016/j.ecl.2023.01.001
8. FRANCHIS R, et al. Baveno VII – Renewing consensus in portal hypertension. Journal of Hepatology, 2022; 76(4): 959–74. doi: 10.1016/j.jhep.2021.12.022.
9. GIDENER T, et al. Liver stiffness by magnetic resonance elastography predicts future cirrhosis, decompensation, and death in NAFLD. Clin Gastroenterol Hepatol., 2021; 19: 1915–24. doi: 10.1016/j.cgh.2020.09.044.
10. HADI HE, et al. Cardio-Metabolic Disorders in Non-Alcoholic Fatty Liver Disease. International Journal of Molecular Sciences, 2019, 20(9): 2215. doi: 10.3390/ijms20092215.
11. HORST KWT e SERLIE MJ. Fructose Consumption, Lipogenesis, and Non-Alcoholic Fatty Liver Disease. Nutrients, 2017; 9(9): 981. doi: 10.3390/nu9090981.
12. HSU C, et al. Magnetic resonance vs transient elastography analysis of patients with nonalcoholic fatty liver disease: a systematic review and pooled analysis of individual participants. Clin Gastroenterol Hepatol., 2019; 17: 630–7. doi: 10.1016/j.cgh.2018.05.059.
13. KAWAGUCHI T, et al. MAFLD: Renovation of clinical practice and disease awareness of fatty liver. Hepatol Res., 2022; 52(5): 422-432. doi: 10.1111/hepr.13706.
14. KAYA E e YILMAZ Y. Epidemiology, natural history, and diagnosis of metabolic dysfunction-associated fatty liver disease: a comparative review with nonalcoholic fatty liver disease. Therapeutic Advances in Endocrinology and Metabolism, 2022, 13: 20420188221139650. doi: 10.1177/20420188221139650.
15. KOUVARI M, et al. Mediterranean diet is inversely associated with steatosis and fibrosis and decreases ten-year diabetes and cardiovascular risk in NAFLD subjects: results from the ATTICA prospective cohort study. Clin Nutr., 2021; 40: 3314–24. doi: 10.1016/j.clnu.2020.10.058
16. KUCHAY MS, et al. Effect of empagliflozin on liver fat in patients with type 2 diabetes and nonalcoholic fatty liver disease: a randomized controlled trial (E-LIFT trial). Diabetes Care, 2018; 41: 1801–8. doi: 10.2337/dc18-0165.
17. LEUNG PB, et al. Diagnosis and Management of Nonalcoholic Fatty Liver Disease. JAMA, 2023; 330(17): 1687-8. doi: 10.1001/jama.2023.17935.
18. MACHADO MV e CORTEZ-PINTO H. Non-invasive diagnosis of non-alcoholic fatty liver disease. A critical appraisal. Journal of Hepatology, 2013, 58:1007-19.
19. MIWA T, et al. Impact of body fat accumulation on metabolic dysfunction-associated fatty liver disease and nonalcoholic fatty liver disease in Japanese male young adults. Hepatol Res., 2023; 53(8): 691-700. doi: 10.1111/hepr.13906.
20. NALBANTOGLU I e BRUNT EM. Role of liver biopsy in nonalcoholic fatty liver disease. World J Gastroenterol, 2014; 20(27): 9026-9037. doi: 10.3748/wjg.v20.i27.9026.
21. PARK CC, et al. Magnetic resonance elastography vs transient elastography in detection of fibrosis and noninvasive measurement of steatosis in patients with biopsy-proven nonalcoholic fatty liver disease. Gastroenterology, 2017; 152(3): 598–607. doi: 10.1053/j.gastro.2016.10.026.
22. PETTA S, et al. Monitoring occurrence of liver-related events and survival by transient elastography in patients with nonalcoholic fatty liver disease and compensated advanced chronic liver disease. Clin Gastroenterol Hepatol., 2021; 19(4): 806–15. doi: 10.1016/j.cgh.2020.06.045.
23. PISCAGLIA F, et al. The role of ultrasound elastographic techniques in chronic liver disease: current status and future perspectives. Eur J Radiol., 2014; 83(3): 450-5. doi: 10.1016/j.ejrad.2013.06.009.
24. RINELLA ME, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology, 2023; 78(6): 1966-86. doi: 10.1097/HEP.0000000000000520.
25. SAADEH S, et al. The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology, 2002; 123(3): 745-50. doi: 10.1053/gast.2002.35354.
26. SEMMLER G, et al. Diet and exercise in NAFLD/NASH: beyond the obvious. Liver Int., 2021; 41(10): 2249–68. doi: 10.1111/liv.15024.
27. SILVA DR, et al. Síndrome metabólica: seus riscos e malefícios para a saúde. Revista Eletrônica Acervo Saúde, 2024; 24(2): e15138.
28. SILVA LCM, et al. Ultrasound elastography in patients with fatty liver disease. Radiol Bras., 2020; 53(1): 47–55. Doi: 10.1590/0100-3984.2019.0028
29. SONG BG, et al. Metabolic dysfunction-associated fatty liver disease and the risk of hepatocellular carcinoma. JHEP Rep., 2023; 5(9): 100810. doi: 10.1016/j.jhepr.2023.100810.
30. TAPPER EB, et al. Simple non-invasive biomarkers of advanced fibrosis in the evaluation of non-alcoholic fatty liver disease. Gastroenterology Report., 2014; 2(4): 276-80. doi: 10.1093/gastro/gou034.
31. VESA CM, et al. Molecular Mechanisms of Metabolic Syndrome. Int J Mol Sci., 2024; 25(10): 5452. doi: 10.3390/ijms25105452
32. VILAR-GOMEZ E, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology, 2015; 149(2): 367–78. doi: 10.1053/j.gastro.2015.04.005.
33. WEIB J, et al. Non-alcoholic fatty liver disease— epidemiology, clincal course, investigation and treatment. Dtsch Arztebl Int., 2014; 111: 447–52.
34. YONEDA M, et al. Nonalcoholic fatty liver disease: US-based acoustic radiation force impulse elastography. Radiology, 2010; 256: 640-7.
35. YUE H e YIN l. Relationship between living habits and metabolic diseases in community populations based on ultrasound diagnosis of nafld. Rev bras med esporte, 2021; 27(spe): 37–9. doi: 10.1590/1517-8692202127012020_0094.
36. ZHANG X, et al. Excess body weight: Novel insights into its roles in obesity comorbidities. Semin Cancer Biol., 2023; 92: 16-27. doi:10.1016/j.semcancer.2023.03.00.