Amarapurkar Deepak N, Hashimoto Estsuko, Lesmana Laurentius A, Sollano José D, Chen Pei-Jer, Goh Khean-Lee
Bombay Hospital and Medical Research Center, Mumbai, India.
J Gastroenterol Hepatol. 2007 Jun;22(6):788-93. doi: 10.1111/j.1440-1746.2007.05042.x.
Risk factors for development of non-alcoholic steatohepatitis include obesity, especially central adiposity, glucose intolerance or type 2 diabetes mellitus (T2DM), and dyslipidemia. Non-alcoholic fatty liver disease (NAFLD) is now considered a manifestation of metabolic syndrome. During the last two decades, NAFLD has become the most common chronic liver disease in North America and Europe, but until recently was thought to be uncommon (perhaps due to the lack of study) in Asia. Fatty liver can be identified on imaging modalities (ultrasonography, computed tomography scans, and magnetic resonance imaging) with high sensitivity, but steatohepatitis and fibrosis cannot be distinguished. Thus, an inherent drawback in studying the epidemiology of NAFLD is the lack of definitive laboratory tests, no uniform definition-with different studies using cut-off values of alcohol consumption from <20 g/week to 210 g/week, and case selections where biopsy was used for definition. In studies outside the region, the prevalence of NAFLD varies from 16% to 42% by imaging, and 15-39% of liver biopsies. The major risk factors for NAFLD, central obesity, T2DM, dyslipidemia, and metabolic syndrome, are now widely prevalent and are increasing geometrically in the Asia-Pacific region. It is therefore not surprising that NAFLD is common in this region. Estimates of current prevalence range from 5% to 30%, depending on the population studied. Central obesity, diabetes, and metabolic syndrome are the major risk factors. To date, however, data on the natural history and impact of NAFLD causing serious significant chronic liver disease are lacking and there is a need for prospective, cooperative studies.
非酒精性脂肪性肝炎的发病风险因素包括肥胖，尤其是腹型肥胖、葡萄糖耐量异常或2型糖尿病（T2DM）以及血脂异常。非酒精性脂肪性肝病（NAFLD）现被视为代谢综合征的一种表现。在过去二十年中，NAFLD已成为北美和欧洲最常见的慢性肝病，但直到最近，在亚洲它仍被认为并不常见（可能是由于研究不足）。通过成像检查（超声、计算机断层扫描和磁共振成像）能够以较高的灵敏度识别脂肪肝，但无法区分脂肪性肝炎和肝纤维化。因此，研究NAFLD流行病学存在一个固有缺陷，即缺乏明确的实验室检测方法，没有统一的定义——不同研究采用的酒精摄入量截断值从每周<20克到210克不等，且病例选择中活检用于定义的情况也各不相同。在该地区以外的研究中，通过成像检查NAFLD的患病率在16%至42%之间，肝活检的患病率在15%至39%之间。NAFLD的主要风险因素，即腹型肥胖、T2DM、血脂异常和代谢综合征，目前在亚太地区广泛流行且呈几何级数增长。因此，NAFLD在该地区很常见也就不足为奇了。根据所研究的人群不同，目前患病率的估计范围在5%至30%之间。腹型肥胖、糖尿病和代谢综合征是主要风险因素。然而，迄今为止，关于NAFLD导致严重慢性肝病的自然史和影响的数据仍然缺乏，需要开展前瞻性合作研究。
