Williams Tracy
Department of Family and Community Medicine at the University of Kansas School of Medicine-Wichita, 707 N. Emporia, Wichita, KS 67214.
FP Essent. 2015 Aug;435:24-9.
Although nonalcoholic fatty liver disease (NAFLD) is not one of the defining criteria for metabolic syndrome, it is a common hepatic manifestation. NAFLD includes a spectrum of histologic findings ranging from simple steatosis, known as nonalcoholic fatty liver, to nonalcoholic steatohepatitis (NASH). To make the diagnosis of NAFLD, other etiologies of steatosis or hepatitis, such as hepatotoxic drugs, excessive alcohol intake, congenital errors of metabolism, or viral hepatitis, must be ruled out. After ruling out other conditions, the diagnosis of NAFLD often is made clinically, but a definitive diagnosis of NASH requires liver biopsy. As with other complications of metabolic syndrome, insulin resistance is thought to be an underlying etiology of NAFLD. Management strategies attempt to reverse or improve insulin resistance while minimizing liver damage. The strongest evidence supports lifestyle modifications with weight loss, but there is some evidence to support bariatric surgery, medical therapy with insulin-sensitizing agents, and/or pharmacotherapy to promote weight loss. Cardiovascular disease is the major cause of mortality in patients with NAFLD, so management must include modification of cardiovascular risk factors.
尽管非酒精性脂肪性肝病（NAFLD）并非代谢综合征的定义标准之一，但它是一种常见的肝脏表现。NAFLD包括一系列组织学表现，从单纯性脂肪变性（即非酒精性脂肪肝）到非酒精性脂肪性肝炎（NASH）。要诊断NAFLD，必须排除其他导致脂肪变性或肝炎的病因，如肝毒性药物、过量饮酒、先天性代谢缺陷或病毒性肝炎。排除其他情况后，NAFLD通常通过临床诊断，但NASH的确切诊断需要肝活检。与代谢综合征的其他并发症一样，胰岛素抵抗被认为是NAFLD的潜在病因。管理策略旨在逆转或改善胰岛素抵抗，同时尽量减少肝脏损伤。最有力的证据支持通过减肥进行生活方式改变，但也有一些证据支持减肥手术、使用胰岛素增敏剂进行药物治疗和/或促进减肥的药物治疗。心血管疾病是NAFLD患者死亡的主要原因，因此管理必须包括对心血管危险因素的调整。
