Targher G, Marra F, Marchesini G
Department of Biomedical and Surgical Sciences, University of Verona, Ospedale Civile Maggiore, Verona, Italy.
Diabetologia. 2008 Nov;51(11):1947-53. doi: 10.1007/s00125-008-1135-4. Epub 2008 Sep 2.
Non-alcoholic fatty liver disease (NAFLD), comprising a spectrum of conditions ranging from pure steatosis to steatohepatitis and cirrhosis, has reached epidemic proportions and represents the most common cause of chronic liver disease in the community. The prevalence of NAFLD has been estimated to be between 20% and 30% in the general population, but this value is much higher ( approximately 70-80%) in type 2 diabetic patients, who are also at higher risk of developing advanced fibrosis and cirrhosis. Increasing recognition of the importance of NAFLD and its strong relationship with the metabolic syndrome has stimulated an interest in the possible role of NAFLD in the development of cardiovascular disease (CVD). Several epidemiological studies indicate that NAFLD, especially in its more severe forms, is linked to an increased risk of CVD, independently of underlying cardiometabolic risk factors. This suggests that NAFLD is not merely a marker of CVD, but may also be actively involved in its pathogenesis. The possible molecular mediators linking NAFLD and CVD include the release of pro-atherogenic factors from the liver (C-reactive protein, fibrinogen, plasminogen activator inhibitor-1 and other inflammatory cytokines) as well as the contribution of NAFLD per se to whole-body insulin resistance and atherogenic dyslipidemia, in turn favouring CVD progression. The clinical impact of NAFLD on CVD risk deserves particular attention in view of the implications for screening and surveillance strategies in the growing number of patients with NAFLD.
非酒精性脂肪性肝病（NAFLD）涵盖了从单纯性脂肪肝到脂肪性肝炎和肝硬化等一系列病症，已达到流行程度，是社区中慢性肝病最常见的病因。据估计，普通人群中NAFLD的患病率在20%至30%之间，但在2型糖尿病患者中这一数值要高得多（约70 - 80%），他们发生晚期肝纤维化和肝硬化的风险也更高。对NAFLD重要性及其与代谢综合征密切关系的认识不断提高，激发了人们对NAFLD在心血管疾病（CVD）发生发展中可能作用的兴趣。多项流行病学研究表明，NAFLD，尤其是其更严重的形式，与CVD风险增加有关，独立于潜在的心脏代谢危险因素。这表明NAFLD不仅是CVD的一个标志物，还可能积极参与其发病机制。连接NAFLD和CVD的可能分子介质包括肝脏释放促动脉粥样硬化因子（C反应蛋白、纤维蛋白原、纤溶酶原激活物抑制剂-1和其他炎性细胞因子），以及NAFLD本身对全身胰岛素抵抗和致动脉粥样硬化血脂异常的影响，进而促进CVD进展。鉴于NAFLD患者数量不断增加，其对CVD风险的临床影响在筛查和监测策略方面的意义值得特别关注。
