Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Dig Dis. 2010;28(1):186-91. doi: 10.1159/000282084. Epub 2010 May 7.
Over the last few years, the paradigm in hepatology has changed from focusing on a single liver disease to considering concurrent diseases, in particular obesity and related metabolic factors. Obesity has reached epidemic proportions globally and is associated with insulin resistance, steatosis and a low-grade systemic inflammatory state. These metabolic factors have a synergistic role in the natural history and treatment outcomes related to chronic liver disease. This is characterized best in chronic hepatitis C where steatosis and insulin resistance are caused by viral and metabolic effects. Non-alcoholic fatty liver disease and related metabolic abnormalities also exacerbate other diseases, such as alcoholic liver disease and haemochromatosis. In addition, there is growing evidence linking obesity and type 2 diabetes with hepatocellular carcinoma in subjects with chronic viral hepatitis. The pathogenesis of co-morbid disease may be related to increased oxidative stress, inflammatory injury and cell death, along with altered hepatocyte regeneration and repair. Hyperinsulinaemia and other metabolic factors may also have a direct role in the progression of liver injury. Data indicate that weight reduction improves steatosis and inflammation in patients with chronic hepatitis C. This has important clinical and therapeutic implications and suggests that obesity should be actively addressed in the management of patients with other chronic liver diseases.
在过去的几年中，肝脏病学的研究模式已经从关注单一肝病转变为同时考虑多种疾病，特别是肥胖和相关代谢因素。肥胖已在全球范围内达到流行程度，并与胰岛素抵抗、脂肪变性和低度全身炎症状态有关。这些代谢因素在慢性肝病的自然史和治疗结果中具有协同作用。这在慢性丙型肝炎中表现得最为明显，其中脂肪变性和胰岛素抵抗是由病毒和代谢因素引起的。非酒精性脂肪性肝病和相关代谢异常也会加重其他疾病，如酒精性肝病和血色病。此外，越来越多的证据表明肥胖和 2 型糖尿病与慢性病毒性肝炎患者的肝细胞癌有关。合并疾病的发病机制可能与氧化应激、炎症损伤和细胞死亡增加有关，同时伴有肝细胞再生和修复的改变。高胰岛素血症和其他代谢因素也可能在肝损伤的进展中发挥直接作用。数据表明，减肥可改善慢性丙型肝炎患者的脂肪变性和炎症。这具有重要的临床和治疗意义，并表明肥胖应在其他慢性肝病患者的管理中得到积极解决。
