Endocrinology, Diabetes and Metabolic Diseases, University and Azienda Ospedaliera Universitaria Integrata of Verona, Ospedale Civile Maggiore, Piazzale Stefani 1, 37126 Verona, Italy.
Nat Rev Gastroenterol Hepatol. 2012 May 8;9(7):372-81. doi: 10.1038/nrgastro.2012.79.
NAFLD is very common in the general population and its prevalence is increasing worldwide in parallel with the increasing incidences of obesity and metabolic diseases, mainly type 2 diabetes. In some cases, however, the diagnosis of NAFLD remains uncertain because other causes of liver disease are not easy to exclude in patients who are diagnosed with NAFLD after a biochemical or ultrasonographic analysis. Several studies have documented a strong association between NAFLD and traditional and nontraditional risk factors for cardiovascular disease (CVD) and chronic kidney disease (CKD). Accordingly, patients with NAFLD have an increased prevalence and incidence of both CVD and CKD. It is reasonable to believe that NAFLD, CVD and CKD share common risk factors (such as visceral obesity, insulin resistance, dysglycaemia, dyslipidaemia and hypertension) and therefore that NAFLD might simply be a marker rather than a causal risk factor of CVD and CKD. In this context, the identification of NAFLD might be an additional clinical feature to improve the stratification of patients for their risk of CVD and CKD. Growing evidence suggests that in patients with NAFLD, especially if NASH is present, several molecules released from the steatotic and inflamed liver might have pathogenic roles in the development of atherosclerosis and kidney damage. If these findings are confirmed by further studies, NAFLD could become a target for the prevention and treatment of CVD and CKD. NAFLD, whatever its role (marker or causal risk factor), is therefore a clinical condition that deserves greater attention from gastroenterologists, endocrinologists, cardiologists and nephrologists, as well as internists and general practitioners.
非酒精性脂肪性肝病（NAFLD）在普通人群中非常常见，其患病率在全球范围内与肥胖和代谢性疾病（主要是 2 型糖尿病）的发病率呈平行上升趋势。然而，在某些情况下，NAFLD 的诊断仍然存在不确定性，因为在经过生化或超声分析诊断为 NAFLD 的患者中，其他肝病病因并不容易排除。多项研究表明，NAFLD 与心血管疾病（CVD）和慢性肾脏病（CKD）的传统和非传统危险因素之间存在很强的关联性。因此，NAFLD 患者 CVD 和 CKD 的患病率和发生率均增加。可以合理地认为，NAFLD、CVD 和 CKD 具有共同的危险因素（如内脏肥胖、胰岛素抵抗、糖代谢异常、血脂异常和高血压），因此 NAFLD 可能仅仅是 CVD 和 CKD 的一个标志物而不是因果危险因素。在这种情况下，NAFLD 的识别可能是改善 CVD 和 CKD 风险分层的另一个临床特征。越来越多的证据表明，在患有 NAFLD 的患者中，特别是在存在 NASH 的情况下，从脂肪变性和炎症的肝脏中释放的几种分子可能在动脉粥样硬化和肾脏损伤的发展中具有致病作用。如果这些发现得到进一步研究的证实，NAFLD 可能成为预防和治疗 CVD 和 CKD 的靶点。因此，无论其作用如何（标志物或因果危险因素），NAFLD 都是一种值得胃肠病学家、内分泌学家、心脏病学家和肾脏病学家以及内科医生和普通科医生更加关注的临床情况。
