Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK; Southampton National Institute for Health Research, Biomedical Research Centre, University Hospital Southampton, UK.
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
J Hepatol. 2015 Apr;62(1 Suppl):S47-64. doi: 10.1016/j.jhep.2014.12.012.
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in Western countries that is predicted to become also the most frequent indication for liver transplantation by 2030. Over the last decade, it has been shown that the clinical burden of NAFLD is not only confined to liver-related morbidity and mortality, but there is now growing evidence that NAFLD is a multisystem disease, affecting extra-hepatic organs and regulatory pathways. For example, NAFLD increases risk of type 2 diabetes mellitus (T2DM), cardiovascular (CVD) and cardiac diseases, and chronic kidney disease (CKD). Although the primary liver pathology in NAFLD affects hepatic structure and function to cause morbidity and mortality from cirrhosis, liver failure and hepatocellular carcinoma, the majority of deaths among NAFLD patients are attributable to CVD. This narrative review focuses on the rapidly expanding body of clinical evidence that supports the concept of NAFLD as a multisystem disease. The review discusses the factors involved in the progression of liver disease in NAFLD and the factors linking NAFLD with other extra-hepatic chronic diseases, such as T2DM, CVD, cardiac diseases and CKD. The review will not discuss NAFLD treatments as these are discussed elsewhere in this issue of the Journal. For this review, PubMed was searched for articles using the keywords "non-alcoholic fatty liver disease" or "fatty liver" combined with "diabetes", "cardiovascular (or cardiac) disease", "cardiovascular mortality" or "chronic kidney disease" between 1990 and 2014. Articles published in languages other than English were excluded.
非酒精性脂肪性肝病（NAFLD）是西方国家最常见的慢性肝病病因，预计到 2030 年，它也将成为肝移植最常见的适应证。在过去十年中，人们已经认识到，NAFLD 的临床负担不仅限于与肝脏相关的发病率和死亡率，而且现在有越来越多的证据表明，NAFLD 是一种多系统疾病，影响肝外器官和调节途径。例如，NAFLD 增加了 2 型糖尿病（T2DM）、心血管疾病（CVD）和心脏疾病以及慢性肾脏病（CKD）的风险。尽管 NAFLD 的主要肝脏病理改变影响肝脏结构和功能，导致肝硬化、肝衰竭和肝细胞癌的发病率和死亡率，但 NAFLD 患者的大多数死亡归因于 CVD。本综述重点介绍了迅速增多的临床证据，这些证据支持将 NAFLD 视为一种多系统疾病的概念。本文讨论了导致 NAFLD 患者肝脏疾病进展的相关因素，以及将 NAFLD 与其他肝外慢性疾病（如 T2DM、CVD、心脏疾病和 CKD）联系起来的相关因素。本文将不讨论 NAFLD 的治疗方法，因为这些内容在本期刊的其他文章中已有讨论。为了进行本次综述，我们在 PubMed 上使用关键词“非酒精性脂肪性肝病”或“脂肪肝”，联合“糖尿病”、“心血管疾病（或心脏疾病）”、“心血管死亡率”或“慢性肾脏病”，对 1990 年至 2014 年间的文章进行了检索。排除了非英语发表的文章。
