Australian National University Medical School, Australia.
J Gastroenterol Hepatol. 2010 Apr;25(4):672-90. doi: 10.1111/j.1440-1746.2010.06253.x.
The strong relationship between over-nutrition, central obesity, insulin resistance/metabolic syndrome and non-alcoholic fatty liver disease (NAFLD) suggest pathogenic interactions, but key questions remain. NAFLD starts with over-nutrition, imbalance between energy input and output for which the roles of genetic predisposition and environmental factors (diet, physical activity) are being redefined. Regulation of energy balance operates at both central nervous system and peripheral sites, including adipose and liver. For example, the endocannabinoid system could potentially be modulated to provide effective pharmacotherapy of NAFLD. The more profound the metabolic abnormalities complicating over-nutrition (glucose intolerance, hypoadiponectinemia, metabolic syndrome), the more likely is NAFLD to take on its progressive guise of non-alcoholic steatohepatitis (NASH). Interactions between steatosis and insulin resistance, visceral adipose expansion and subcutaneous adipose failure (with insulin resistance, inflammation and hypoadiponectinemia) trigger amplifying mechanisms for liver disease. Thus, transition from simple steatosis to NASH could be explained by unmitigated hepatic lipid partitioning with failure of local adaptive mechanisms leading to lipotoxicity. In part one of this review, we discuss newer concepts of appetite and metabolic regulation, bodily lipid distribution, hepatic lipid turnover, insulin resistance and adipose failure affecting adiponectin secretion. We review evidence that NASH only occurs when over-nutrition is complicated by insulin resistance and a highly disordered metabolic milieu, the same 'metabolic movers' that promote type 2 diabetes and atheromatous cardiovascular disease. The net effect is accumulation of lipid molecules in the liver. Which lipids and how they cause injury, inflammation and fibrosis will be discussed in part two.
营养过剩、中心性肥胖、胰岛素抵抗/代谢综合征与非酒精性脂肪性肝病(NAFLD)之间的密切关系提示其间存在发病机制的相互作用,但仍存在一些关键问题。NAFLD 起始于营养过剩,即能量摄入与消耗之间的失衡,而遗传易感性和环境因素(饮食、体力活动)在其中的作用正在被重新定义。能量平衡的调节作用发生于中枢神经系统和外周组织,包括脂肪组织和肝脏。例如,内源性大麻素系统可能会被调节,从而为 NAFLD 的有效药物治疗提供可能。当营养过剩时所并发的代谢异常越严重(葡萄糖耐量异常、脂联素水平降低、代谢综合征),NAFLD 就越有可能进展为非酒精性脂肪性肝炎(NASH)。脂肪变性和胰岛素抵抗、内脏脂肪扩张和皮下脂肪衰竭(伴有胰岛素抵抗、炎症和脂联素水平降低)之间的相互作用会引发肝脏疾病的放大机制。因此,从单纯性脂肪变性向 NASH 的转变可以用肝脏脂质重新分布而局部适应性机制失效导致脂质毒性来解释。在这篇综述的第一部分,我们讨论了食欲和代谢调节、身体脂肪分布、肝脏脂质周转、胰岛素抵抗和影响脂联素分泌的脂肪组织衰竭等方面的新概念。我们综述了以下证据:只有当营养过剩并发胰岛素抵抗和高度紊乱的代谢环境时,才会发生 NASH,而这些正是促进 2 型糖尿病和动脉粥样硬化性心血管疾病的“代谢驱动因素”。其净效应是脂质分子在肝脏中的堆积。在第二部分中,我们将讨论哪些脂质以及它们如何导致损伤、炎症和纤维化。