Reynaert H, Geerts A, Henrion J
Department of Gastroenterology-Hepatology, University Hospital AZ-VUB, Brussels, Belgium.
Aliment Pharmacol Ther. 2005 Nov 15;22(10):897-905. doi: 10.1111/j.1365-2036.2005.02682.x.
It is generally accepted that non-alcoholic fatty liver disease will be the most frequent liver disease in the near future and that the management of patients with non-alcoholic fatty liver disease will be a challenge for hepatologists in the next decades. Non-alcoholic fatty liver disease is considered the hepatic manifestation of the metabolic syndrome, in which insulin resistance plays a crucial role. Although steatosis will often not progress to severe liver disease, in some patients, it results in cirrhosis and even hepatocellular carcinoma. Therefore, it is important to identify those patients at risk for developing fibrosis. Age, diabetes, obesity and hypertriglyceridaemia are independent risk factors for fibrosis in patients with elevated serum alanine aminotransferase levels and steatosis on ultrasound. The presence of multiple metabolic disorders increases the risk. Apart from diet, exercise and correction of underlying metabolic abnormalities, no specific treatment is available at the moment. Theoretically, thiazolidinediones are an attractive way to treat non-alcoholic fatty liver disease, because they improve insulin resistance. Some preliminary studies with thiazolidinediones were encouraging, as steatosis, inflammation and fibrosis improved in a substantial number of patients. Although no serious side effects occurred in the pilot studies, we should look vigilantly for hepatotoxicity, as the first generation thiazolidinediones proved to be toxic for the liver.
人们普遍认为，非酒精性脂肪性肝病在不久的将来将成为最常见的肝脏疾病，并且在未来几十年里，非酒精性脂肪性肝病患者的管理将成为肝病学家面临的一项挑战。非酒精性脂肪性肝病被认为是代谢综合征的肝脏表现，其中胰岛素抵抗起着关键作用。虽然脂肪变性通常不会进展为严重的肝脏疾病，但在一些患者中，它会导致肝硬化甚至肝细胞癌。因此，识别那些有发生纤维化风险的患者很重要。年龄、糖尿病、肥胖和高甘油三酯血症是血清丙氨酸氨基转移酶水平升高且超声显示有脂肪变性的患者发生纤维化的独立危险因素。多种代谢紊乱的存在会增加风险。除了饮食、运动和纠正潜在的代谢异常外，目前尚无特效治疗方法。从理论上讲，噻唑烷二酮类药物是治疗非酒精性脂肪性肝病的一种有吸引力的方法，因为它们可以改善胰岛素抵抗。一些关于噻唑烷二酮类药物的初步研究令人鼓舞，因为大量患者的脂肪变性、炎症和纤维化都有所改善。虽然在试点研究中没有出现严重的副作用，但我们应该警惕肝毒性，因为第一代噻唑烷二酮类药物已被证明对肝脏有毒性。
