Boppidi Hima, Daram Sumanth R
Department of Medicine, St. Joseph Hospital, Milwaukee, WI, 53210, USA.
Postgrad Med. 2008 Jul 31;120(2):E01-7. doi: 10.3810/pgm.2008.07.1800.
Obesity is currently a worldwide epidemic, and will likely only increase in prevalence in the coming years. The incidence of the metabolic syndrome (MetS) seems to be paralleling obesity. The MetS is strongly linked to insulin resistance, abdominal obesity, diabetes mellitus, and dyslipidemia. Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of obesity and the MetS. Although not currently a formal component of the MetS, data suggest a very strong correlation between NAFLD and the MetS; insulin resistance appears to be the common factor. Nonalcoholic steatohepatitis (NASH) is a more advanced stage in the spectrum of NAFLD, which can progress to cirrhosis. Management strategies for NAFLD are conceivably similar to those for the MetS, which focus on lifestyle measures aimed at weight reduction and maintenance. The purpose of this review is to highlight the growing epidemic of obesity and the MetS, and the strong likelihood of an increase in the prevalence of the already widely existent combination of NAFLD/NASH. This article describes pharmacological treatments including novel therapies aimed at the hepatic pathophysiologic process, as well as surgical options. The increasing prevalence of obesity and the MetS places a large population at risk for developing hepatic failure. Therefore, NAFLD must be acknowledged as a major worldwide public health concern.
肥胖目前是一种全球性的流行病，而且在未来几年其患病率可能只会上升。代谢综合征（MetS）的发病率似乎与肥胖情况同步。MetS与胰岛素抵抗、腹型肥胖、糖尿病和血脂异常密切相关。非酒精性脂肪性肝病（NAFLD）是肥胖和MetS的肝脏表现。虽然目前NAFLD并非MetS的正式组成部分，但数据表明NAFLD与MetS之间存在非常强的相关性；胰岛素抵抗似乎是共同因素。非酒精性脂肪性肝炎（NASH）是NAFLD谱系中更严重的阶段，可进展为肝硬化。NAFLD的管理策略可以想象与MetS的管理策略相似，后者侧重于旨在减轻体重和维持体重的生活方式措施。本综述的目的是强调肥胖和MetS日益流行的情况，以及NAFLD/NASH这种已广泛存在的组合患病率增加的极大可能性。本文介绍了包括针对肝脏病理生理过程的新型疗法在内的药物治疗方法以及手术选择。肥胖和MetS患病率的不断上升使大量人群面临发生肝衰竭的风险。因此，必须认识到NAFLD是一个重大的全球公共卫生问题。
