Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Ann N Y Acad Sci. 2013 Apr;1281(1):106-22. doi: 10.1111/nyas.12016. Epub 2013 Jan 30.
Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in the Western world and its incidence is increasing rapidly. NAFLD is a spectrum ranging from simple steatosis, which is relatively benign hepatically, to nonalcoholic steatohepatitis (NASH), which can progress to cirrhosis. Obesity, insulin resistance, type 2 diabetes mellitus, and dyslipidemia are the most important risk factors for NAFLD. Due to heavy enrichment with metabolic risk factors, individuals with NAFLD are at significantly higher risk for cardiovascular disease. Individuals with NAFLD have higher incidence of type 2 diabetes. The diagnosis of NAFLD requires imaging evidence of hepatic steatosis in the absence of competing etiologies including significant alcohol consumption. Liver biopsy remains the gold standard for diagnosing NASH and for determining prognosis. Weight loss remains a cornerstone of treatment. Weight loss of ~5% is believed to improve steatosis, whereas ~10% weight loss is necessary to improve steatohepatitis. A number of pharmacologic therapies have been investigated to treat NASH, and agents such as vitamin E and thiazolidinediones have shown promise in select patient subgroups.
非酒精性脂肪性肝病（NAFLD）是西方国家最常见的肝脏疾病，其发病率正在迅速上升。NAFLD 是一个谱，从相对良性的单纯性脂肪变性到非酒精性脂肪性肝炎（NASH），后者可进展为肝硬化。肥胖、胰岛素抵抗、2 型糖尿病和血脂异常是 NAFLD 的最重要危险因素。由于代谢危险因素的大量富集，NAFLD 患者患心血管疾病的风险显著增加。NAFLD 患者 2 型糖尿病的发病率更高。NAFLD 的诊断需要在没有包括大量饮酒在内的竞争病因的情况下，有影像学证据显示肝脂肪变性。肝活检仍然是诊断 NASH 和确定预后的金标准。减肥仍然是治疗的基石。体重减轻约 5%被认为可以改善脂肪变性，而减轻约 10%的体重则可以改善脂肪性肝炎。已经研究了许多药物治疗来治疗 NASH，并且维生素 E 和噻唑烷二酮等药物在某些患者亚组中显示出了希望。
