Kosmidou Maria, Milionis Haralampos
Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece -
Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece.
Minerva Endocrinol. 2017 Jun;42(2):109-121. doi: 10.23736/S0391-1977.16.02562-1. Epub 2016 Dec 16.
Non alcoholic fatty liver disease (NAFLD, the hepatic fat accumulation) and non alcoholic steatohepatitis (NASH, the aggressive form of liver steatosis plus inflammation and hepatocyte necrosis) are reaching epidemic dimensions in subjects with diabetes mellitus (DM). Taking into account that the incidence of DM increases worldwide, these entities represent major health problems. There is accumulating evidence that diabetic subjects with NASH are at increased risk not only for cardiovascular disease compications but also for cirrhosis and hepatocellular cancer. On the other hand, the presence of NAFLD correlates with an increased risk for the development of DM. The most-widely accepted pathophysiological mechanisms relating DM and NAFLD include central obesity and insulin resistanc, but new insights are under scrutiny. Therapeutic modalities used for the management of diabetes have been studied for their impact on NAFLD/NASH and both neutral and beneficial effects have been reported. In this review, we discuss issues regarding the epidemiology, the pathophysiological pathways relating NAFLD with DM and consider strategies that may be useful in the management of NAFLD in the diabetic population.
非酒精性脂肪性肝病（NAFLD，即肝脏脂肪堆积）和非酒精性脂肪性肝炎（NASH，肝脏脂肪变性的侵袭性形式，伴有炎症和肝细胞坏死）在糖尿病（DM）患者中已呈流行态势。鉴于全球糖尿病发病率不断上升，这些病症已成为重大健康问题。越来越多的证据表明，患有NASH的糖尿病患者不仅患心血管疾病并发症的风险增加，患肝硬化和肝细胞癌的风险也会增加。另一方面，NAFLD的存在与患糖尿病风险的增加相关。糖尿病与NAFLD之间最广泛接受的病理生理机制包括中心性肥胖和胰岛素抵抗，但新的见解仍在研究之中。用于糖尿病管理的治疗方法对NAFLD/NASH的影响已得到研究，有报道称其既有中性作用也有有益作用。在本综述中，我们讨论了有关流行病学、NAFLD与糖尿病相关的病理生理途径等问题，并考虑了可能有助于管理糖尿病患者NAFLD的策略。
