摘要Objective To investigate risk factors associated with significant histologic lesions in metabolic dysfunction-associated steatotic liver disease(MASLD)using the SAF(Steatosis,Activity,Fibrosis)scoring system and to develop a risk prediction model.Methods In this retrospective cohort of 415 biopsy-proven MASLD patients(2018-2022),participants were stratified into significant lesion(SAF activity grade≥3 and/or fibrosis stage≥3,n=131)and non-significant lesion(activity<3 and fibrosis<3,n=284)groups.Demographic,laboratory,and imaging parameters including platelet count(PLT),aspartate aminotransferase(AST),alanine aminotransferase(ALT),gamma-glutamyl transferase(GGT),alkaline phosphatase(ALP),total bilirubin(TBIL),direct bilirubin(DBIL),total bile acids(TBA),triglycerides(TG),total cholesterol(TC),fasting plasma glucose(FPG),uric acid(UA),laminin(LN),hyaluronic acid(HA),procollagen type III(PC-III),collagen type IV(C-IV),controlled attenuation parameter(CAP),and liver stiffness measurement(LSM)were analyzed.Results Patients with significant lesions had higher body mass index(BMI),proportion of high-fat diet,AST,ALT,TBA,UA,CAP,and LSM(all P<0.05).Multivariate logistic regression identified BMI(OR=1.182),UA(OR=1.003),CAP(OR=1.005),and LSM(OR=1.104)as independent predictors of significant histologic lesions,with a model area under the curve of 75.18%.Conclusion BMI,hyperuricemia,hepatic steatosis(CAP),and fibrosis(LSM)are independent risk factors for advanced MASLD.A combined non-invasive assessment may enhance risk stratification in clinical practice.