Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Piazzale Stefani 1, 37126 Verona, Italy.
Nutrition and Metabolism, Faculty of Medicine, University of Southampton.
Nat Rev Nephrol. 2017 May;13(5):297-310. doi: 10.1038/nrneph.2017.16. Epub 2017 Feb 20.
Non-alcoholic fatty liver disease (NAFLD) is caused by an accumulation of fat in the liver; the condition can progress over time to increase the risk of developing cirrhosis, end-stage liver disease and hepatocellular carcinoma. The prevalence of NAFLD is increasing rapidly owing to the global epidemics of obesity and type 2 diabetes mellitus (T2DM), and NAFLD has been predicted to become the most important indication for liver transplantation over the next decade. It is now increasingly clear that NAFLD not only affects the liver but can also increase the risk of developing extra-hepatic diseases, including T2DM, cardiovascular disease and chronic kidney disease (CKD), which have a considerable impact on health-care resources. Accumulating evidence indicates that NAFLD exacerbates insulin resistance, predisposes to atherogenic dyslipidaemia and releases a variety of proinflammatory factors, prothrombotic factors and profibrogenic molecules that can promote vascular and renal damage. Furthermore, communication or 'crosstalk' between affected organs or tissues in these diseases has the potential to further harm function and worsen patient outcomes, and increasing amounts of evidence point to a strong association between NAFLD and CKD. Whether a causal relationship between NAFLD and CKD exists remains to be definitively established.
非酒精性脂肪性肝病（NAFLD）是由肝脏脂肪堆积引起的；随着时间的推移，这种情况会增加发展为肝硬化、终末期肝病和肝细胞癌的风险。由于肥胖和 2 型糖尿病（T2DM）在全球的流行，NAFLD 的患病率迅速上升，预计在未来十年内，NAFLD 将成为肝移植的最重要指征。现在越来越清楚的是，NAFLD 不仅影响肝脏，还会增加发生肝外疾病的风险，包括 2 型糖尿病、心血管疾病和慢性肾脏病（CKD），这对医疗保健资源有相当大的影响。越来越多的证据表明，NAFLD 会加重胰岛素抵抗，导致动脉粥样硬化性血脂异常，并释放多种促炎、促血栓形成和促纤维化分子，从而促进血管和肾脏损伤。此外，这些疾病中受影响的器官或组织之间的通讯或“串扰”有可能进一步损害功能并恶化患者预后，越来越多的证据表明，NAFLD 与 CKD 之间存在很强的关联。NAFLD 和 CKD 之间是否存在因果关系仍有待最终确定。
