Neuschwander-Tetri Brent A
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University Liver Center, St. Louis, Missouri 63110, USA.
Am J Med Sci. 2005 Dec;330(6):326-35. doi: 10.1097/00000441-200512000-00011.
Relatively recently, the liver has been recognized as a major target of injury in patients with insulin resistance or the metabolic syndrome. Insulin resistance is associated with fat accumulation in the liver, a condition called nonalcoholic fatty liver disease (NAFLD). Excess fat in the liver is not a benign condition. Some patients with NAFLD develop necroinflammatory changes in the liver called nonalcoholic steatohepatitis (NASH) and a fraction of those will develop cirrhosis. About 20% all adults have NAFLD and 2% to 3% of adults have NASH. Approximately 20% of patients with NASH are at risk for developing cirrhosis and subsequently dying from end-stage liver disease. The diagnosis of NASH requires a high index of suspicion, especially in obese patients over the age of 45 years who have diabetes, because these are the patients at greatest risk for developing cirrhosis. Treatment focuses on addressing the underlying insulin resistance with increased exercise and weight reduction.
直到最近，肝脏才被认为是胰岛素抵抗或代谢综合征患者的主要损伤靶点。胰岛素抵抗与肝脏脂肪堆积有关，这种情况被称为非酒精性脂肪性肝病（NAFLD）。肝脏中的脂肪过多并非良性状况。一些NAFLD患者会出现肝脏坏死性炎症变化，即非酒精性脂肪性肝炎（NASH），其中一部分患者会发展为肝硬化。所有成年人中约20%患有NAFLD，2%至3%的成年人患有NASH。大约20%的NASH患者有发展为肝硬化并随后死于终末期肝病的风险。NASH的诊断需要高度怀疑，尤其是在45岁以上患有糖尿病的肥胖患者中，因为这些患者发生肝硬化的风险最高。治疗重点是通过增加运动和减轻体重来解决潜在的胰岛素抵抗问题。
