Tilg Herbert, Kaser Arthur
Department of Medicine, Academic Teaching Hospital Hall, Tyrol, Austria.
Nat Clin Pract Gastroenterol Hepatol. 2005 Mar;2(3):148-55. doi: 10.1038/ncpgasthep0116.
Nonalcoholic fatty liver disease (NAFLD) is an increasingly recognized health problem. Increased fat accumulation in the liver is observed in 20-30% of the population in the Western world, and in approximately 10% of this cohort it is associated with nonalcoholic steatohepatitis, which is characterized by inflammation and fibrosis. Disease presentation of NAFLD ranges from asymptomatic disease to cirrhosis with the complication of liver failure and hepatocellular carcinoma. NAFLD is suspected on the basis of various clinical aspects (an elevated alanine aminotransferase concentration, presence of obesity and diabetes) that alone are not sufficient to establish diagnosis or prognosis. The major diagnostic procedure is liver biopsy, which allows assessment of liver injury. In most cases, NAFLD is associated with insulin resistance, which is therefore the target of most current NAFLD treatment modalities. Various treatment strategies such as weight loss and/or exercise, thiazolidinediones, metformin, lipid-lowering agents and antioxidants have been studied. So far, no single intervention has convincingly improved liver histology. It is recommended that patients at high risk of developing advanced liver disease, and who are not part of controlled studies, should receive nutritional counseling and take physical exercise to achieve moderate weight loss and improve insulin sensitivity.
非酒精性脂肪性肝病（NAFLD）是一个日益受到关注的健康问题。在西方世界，20%至30%的人群肝脏中脂肪堆积增加，其中约10%与非酒精性脂肪性肝炎相关，其特征为炎症和纤维化。NAFLD的疾病表现从无症状疾病到伴有肝衰竭和肝细胞癌并发症的肝硬化不等。NAFLD基于各种临床特征（丙氨酸转氨酶浓度升高、肥胖和糖尿病的存在）而被怀疑，但这些特征单独不足以确立诊断或判断预后。主要的诊断方法是肝活检，它能够评估肝损伤。在大多数情况下，NAFLD与胰岛素抵抗相关，因此胰岛素抵抗是当前大多数NAFLD治疗方式的靶点。已经研究了各种治疗策略，如减肥和/或运动、噻唑烷二酮类药物、二甲双胍、降脂药物和抗氧化剂。到目前为止，没有一种单一干预措施能令人信服地改善肝脏组织学。建议有发展为晚期肝病高风险且未参与对照研究的患者接受营养咨询并进行体育锻炼，以实现适度体重减轻并提高胰岛素敏感性。
