Division of Gastroenterology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Ther Clin Risk Manag. 2007 Dec;3(6):1153-63.
Non-alcoholic fatty liver disease, defined as the presence of macrovascular steatosis in the presence of less than 20 gm of alcohol ingestion per day, is the most common liver disease in the USA. It is most commonly associated with insulin resistance/type 2 diabetes mellitus and obesity. It is manifested by steatosis, steatohepatitis, cirrhosis, and, rarely, hepatocellular carcinoma.Hepatic steatosis results from an imbalance between the uptake of fat and its oxidation and export. Insulin resistance, predisposing to lipolysis of peripheral fat with mobilization to and uptake of fatty acids by the liver, is the most consistent underlying pathogenic factor. It is not known why some patients progress to cirrhosis; however, the induction of CYP 2E1 with generation of reactive oxygen species appears to be important.Treatment is directed at weight loss plus pharmacologic therapy targeted toward insulin resistance or dyslipidemia. Bariatric surgery has proved effective. While no pharmacologic therapy has been approved, emerging data on thiazolidinediones have demonstrated improvement in both liver enzymes and histology. There are fewer, but promising data, with statins which have been shown to be hepatoprotective in other liver diseases. The initial enthusiasm for ursodeoxycholic acid has not been supported by histologic studies.
非酒精性脂肪性肝病，定义为每日摄入酒精量少于 20 克时存在大血管脂肪变性，是美国最常见的肝脏疾病。它最常与胰岛素抵抗/2 型糖尿病和肥胖相关。其表现为脂肪变性、脂肪性肝炎、肝硬化，很少出现肝细胞癌。肝脂肪变性是由于脂肪的摄取、氧化和输出之间的失衡所致。胰岛素抵抗促使外周脂肪的脂解，导致脂肪酸向肝脏转移和摄取，这是最一致的潜在致病因素。目前尚不清楚为什么有些患者会进展为肝硬化；然而，诱导 CYP 2E1 产生活性氧似乎很重要。治疗方法是减肥加上针对胰岛素抵抗或血脂异常的药物治疗。减重手术已被证明有效。虽然尚未批准任何药物治疗，但噻唑烷二酮类药物在改善肝酶和组织学方面的新数据显示出了疗效。他汀类药物在其他肝病中具有肝保护作用，也有较少但有希望的数据。熊去氧胆酸最初的热情并没有得到组织学研究的支持。
