Division of Gastroenterology and Hepatology, Department of Medicine Sestre Milosrdnice University Hospital, Zagreb, Croatia.
J Physiol Pharmacol. 2009 Dec;60 Suppl 7:57-66.
Nonalcoholic fatty liver disease (NAFLD), the hepatic manifestation of the metabolic syndrome, has become a common entity in clinical practice. In most of the patients it presents as simple steatosis with nonprogressive clinical course. However, some patients have progressive form of NAFLD, nonalcoholic steatohepatitis (NASH), and are at increased risk of developing cirrhosis and hepatocellular carcinoma. NAFLD treatment includes lifestyle modifications and pharmacotherapy aiming at increasing insulin sensitivity, and attenuating inflammation and hepatic fibrosis. Weight reduction has consistently been shown to reduce levels of liver enzymes and insulin resistance. Although dietary intervention and exercise remain the first-line therapy, due to low patients compliance to these measures pharmacotherapy or surgical approaches are often required. Metformin and thiazolidinediones may improve insulin sensitivity, serum aminotransferase level and liver histology. However, little evidence exists regarding their sustained effects after drug discontinuation which, together with their side effects, limits their widespread use in clinical practice. Statins appear to be safe agents for the treatment of hyperlipidemia, although trials documenting their efficacy in NAFLD are scarce. Based on the recent clinical trials, weight loss medication orlistat, ursodeoxycholic acid and antioxidant agents could potentially be used as adjunctive therapy. Considering still largely controversial clinical data regarding pharmacological agents, their high cost and known side-effects, lifestyle modifications at present remain the only essential considerations in the NAFLD treatment.
非酒精性脂肪性肝病（NAFLD）是代谢综合征的肝脏表现，已成为临床实践中的常见病症。在大多数患者中，其表现为单纯性脂肪变性，临床病程无进展。然而，一些患者存在进展性 NAFLD，即非酒精性脂肪性肝炎（NASH），并且发生肝硬化和肝细胞癌的风险增加。NAFLD 的治疗包括生活方式改变和旨在提高胰岛素敏感性、减轻炎症和肝纤维化的药物治疗。体重减轻已被一致证明可降低肝酶和胰岛素抵抗水平。尽管饮食干预和运动仍然是一线治疗方法，但由于患者对这些措施的依从性低，因此经常需要药物治疗或手术方法。二甲双胍和噻唑烷二酮类药物可能改善胰岛素敏感性、血清氨基转移酶水平和肝脏组织学。然而，停药后其持续效果的证据很少，再加上它们的副作用，限制了它们在临床实践中的广泛应用。他汀类药物似乎是治疗高脂血症的安全药物，尽管证明其在 NAFLD 中的疗效的试验很少。基于最近的临床试验，减肥药物奥利司他、熊去氧胆酸和抗氧化剂可能可作为辅助治疗。鉴于目前关于药物治疗的临床数据仍然存在很大争议、药物费用高且已知存在副作用，因此生活方式改变仍然是非酒精性脂肪性肝病治疗的唯一重要考虑因素。
