Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
Curr Opin Gastroenterol. 2010 May;26(3):202-8. doi: 10.1097/MOG.0b013e328337b0c4.
This review focuses on recent advances in the study of the epidemiology, pathogenesis, natural history and treatment of nonalcoholic fatty liver disease (NAFLD).
Study of hepatic lipid metabolism, insulin resistance, mitochondrial dysfunction and oxidative stress, genetic variants and predisposition to altered metabolism and cell injury have contributed to our current understanding of NAFLD. Differential expression of microRNA in fatty liver and its implication in disease pathogenesis and therapeutic potential have continued to advance over the year. The pathogenesis of hepatocellular carcinoma in steatohepatitis continues to be explored. The diagnostic utility of imaging and noninvasive markers seems promising in estimating the severity of steatosis and fibrosis. Liver biopsy remains the gold standard for accurately assessing NAFLD and steatohepatitis. Lifestyle modification and weight loss improve both metabolic profile and liver histology. Pharmacotherapy for the treatment of NAFLD remains lacking.
The underlying mechanism and pathogenesis of NAFLD remain elusive despite ongoing researches to make significant advances in the understanding of its natural history, pathogenesis and management. Pharmacotherapy has yet to indicate a promising therapeutic intervention. Current treatment focuses on managing underlying cardio-metabolic risks.
本文重点介绍非酒精性脂肪性肝病（NAFLD）的流行病学、发病机制、自然史和治疗的最新进展。
对肝脂代谢、胰岛素抵抗、线粒体功能障碍和氧化应激、遗传变异和易变代谢及细胞损伤的易感性的研究促进了我们对 NAFLD 的认识。脂肪肝中 microRNA 的差异表达及其在疾病发病机制和治疗潜力中的作用在过去一年中不断得到发展。脂肪性肝炎中肝细胞癌的发病机制仍在不断探索中。影像学和非侵入性标志物的诊断效用在评估脂肪变性和纤维化的严重程度方面似乎很有前景。肝活检仍然是准确评估非酒精性脂肪性肝病和脂肪性肝炎的金标准。生活方式的改变和体重的减轻可以改善代谢特征和肝脏组织学。NAFLD 的药物治疗仍然缺乏。
尽管在理解其自然史、发病机制和管理方面取得了重大进展，但 NAFLD 的潜在机制和发病机制仍难以捉摸。药物治疗尚未显示出有希望的治疗干预作用。目前的治疗重点是管理潜在的心脏代谢风险。
