Sevastianos Vassilios A, Hadziyannis Stephanos J
Department of Medicine & Hepatology, Henry Dunant Hospital, 107 Messogion Avenue, 11526 Athens, Greece.
Expert Rev Gastroenterol Hepatol. 2008 Feb;2(1):59-79. doi: 10.1586/17474124.2.1.59.
Nonalcoholic fatty liver disease (NAFLD) is probably the most common spectrum of metabolic liver disease in the world, encompassing simple steatosis to steatohepatitis, advanced fibrosis, cirrhosis and hepatocellular carcinoma. NAFLD affects a significant part of the general population worldwide. The existing correlation between obesity and NAFLD in combination with the increase in the frequency of obesity in the developed world implies that the incidence and severity of NAFLD will increase in the near future. Newer data support the idea that NAFLD constitutes the more important cause of cryptogenic cirrhosis of the liver and a ground for the development of hepatocellular carcinoma. Liver biopsy remains the most specific and sensitive method to differentiate NAFLD, providing important information on the long-term prognosis of the patients. The 'two hit' hypothesis constitutes the currently prevailing theory for the development of NAFLD and nonalcoholic steatohepatitis. The first 'hit' is purported to be the increase of free fatty acids in hepatocytes, which results in a decrease of beta-oxidation. The second step includes all mechanisms contributing to the development of necroinflammation and fibrosis. Currently, an effective treatment for patients with NAFLD does not exist. Improvement in liver histology remains the primary goal of any therapeutic approach in patients with NAFLD. Viewing NAFLD in the frame of the metabolic syndrome opens the possibility that both the onset of the disease and disease progression could be prevented by changes in lifestyle. Physical exercise and a low calorie diet in combination with the gradual loss of body weight represent the cornerstone for the management of NAFLD patients.
非酒精性脂肪性肝病（NAFLD）可能是全球最常见的代谢性肝病谱，涵盖单纯性脂肪变性至脂肪性肝炎、进展性肝纤维化、肝硬化和肝细胞癌。NAFLD影响着全球相当一部分普通人群。肥胖与NAFLD之间现有的相关性，再加上发达国家肥胖发生率的增加，意味着在不久的将来，NAFLD的发病率和严重程度将会上升。最新数据支持这样一种观点，即NAFLD是隐源性肝硬化更重要的病因，也是肝细胞癌发生发展的基础。肝活检仍然是鉴别NAFLD最特异和敏感的方法，可为患者的长期预后提供重要信息。“二次打击”假说构成了目前关于NAFLD和非酒精性脂肪性肝炎发生发展的主流理论。第一次“打击”据说是肝细胞内游离脂肪酸增加，导致β氧化减少。第二步包括所有导致坏死性炎症和纤维化发展的机制。目前，尚无针对NAFLD患者的有效治疗方法。肝脏组织学改善仍然是NAFLD患者任何治疗方法的主要目标。从代谢综合征的角度看待NAFLD，为通过生活方式改变预防疾病的发生和进展提供了可能性。体育锻炼、低热量饮食以及逐渐减轻体重是管理NAFLD患者的基石。
