Chan Henry L-Y, de Silva H Janaka, Leung Nancy W-Y, Lim Seng-Gee, Farrell Geoffrey C
Department of Medicine and Therapeutics and Institute of Digestive Disease, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
J Gastroenterol Hepatol. 2007 Jun;22(6):801-8. doi: 10.1111/j.1440-1746.2007.04977.x.
Evidence-based management guidelines for non-alcoholic fatty liver disease (NAFLD) are lacking in the Asia-Pacific region or elsewhere. This review reports the results of a systematic literature search and expert opinions. The Asia-Pacific Working Party on NAFLD (APWP-NAFLD) has generated practical recommendations on management of NAFLD in this region. NAFLD should be suspected when there are metabolic risk factors and/or characteristic changes on hepatic ultrasonography. Diagnosis by ultrasonography, assessment of liver function and complications, exclusion of other liver diseases and screening for metabolic syndrome comprise initial assessment. Liver biopsy should be considered when there is diagnostic uncertainty, for patients at risk of advanced fibrosis, for those enrolled in clinical trials and at laparoscopy for another purpose. Lifestyle measures such as dietary restrictions and increased physical activity (aerobic exercise) should be encouraged, although the best management strategy to achieve this has yet to be defined. Complications of metabolic syndrome should be screened for regularly. Use of statins to treat hypercholesterolemia is safe and recommended; frequent alanine aminotransferase (ALT) monitoring is not required. Obese patients who do not respond to lifestyle measures should be referred to centers specializing in obesity management; consideration should be given to bariatric surgery or gastric ballooning. The role of pharmacotherapy remains investigational and is not recommended for routine clinical practice. Non-alcoholic fatty liver disease should be recognized as part of the metabolic syndrome and managed in a multidisciplinary approach that addresses liver disease in the context of risk factors for diabetes and premature cardiovascular disease. Lifestyle changes are the first line and mainstay of management.
亚太地区及其他地区缺乏非酒精性脂肪性肝病（NAFLD）的循证管理指南。本综述报告了系统文献检索结果及专家意见。亚太非酒精性脂肪性肝病工作小组（APWP-NAFLD）已针对该地区NAFLD的管理提出了实用建议。当存在代谢风险因素和/或肝脏超声出现特征性改变时，应怀疑患有NAFLD。初始评估包括通过超声进行诊断、评估肝功能及并发症、排除其他肝脏疾病以及筛查代谢综合征。当诊断存在不确定性时、对于有进展性肝纤维化风险的患者、参与临床试验的患者以及因其他目的进行腹腔镜检查的患者，应考虑进行肝活检。应鼓励采取饮食限制和增加体力活动（有氧运动）等生活方式措施，尽管实现这一目标的最佳管理策略尚未明确。应定期筛查代谢综合征的并发症。使用他汀类药物治疗高胆固醇血症是安全的且推荐使用；无需频繁监测丙氨酸氨基转移酶（ALT）。对生活方式措施无反应的肥胖患者应转诊至专门的肥胖管理中心；应考虑进行减重手术或胃内气球置入术。药物治疗的作用仍在研究中，不推荐用于常规临床实践。非酒精性脂肪性肝病应被视为代谢综合征的一部分，并采用多学科方法进行管理，在糖尿病和心血管疾病过早发生的风险因素背景下处理肝脏疾病。生活方式改变是管理的一线措施和主要手段。
