Stengel Joel Z, Harrison Stephen A
Dr. Stengel is a Medical Resident and Dr. Harrison is Chief of Hepatology in the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Brooke Army Medical Center, Fort Sam Houston, Tex.
Gastroenterol Hepatol (N Y). 2006 Jun;2(6):440-449.
Nonalcoholic fatty liver disease (NAFLD) is reaching epidemic proportions in our society and is the most common etiology for patients presenting with elevated liver enzymes. Given the significant numbers of patients presenting with NAFLD, it is important to distinguish between simple fatty liver and nonalcoholic steatohepatitis (NASH). Whereas simple fatty liver is thought to have a benign prognosis generally, NASH may progress to cirrhosis in a subset of patients. Performance of liver biopsies in all NAFLD patients is not feasible but recent studies have identified several clinical factors that may predict the patients at greatest risk for NASH and advanced fibrosis, and thus biopsy procedures may be confined to the patients meeting these criteria. Treatment remains focused on improving the underlying insulin resistance that is invariably present in the majority of patients. Diet and exercise remain the cornerstone of therapy, but insulin-sensitizing medication and other agents aimed at reducing oxidative stress or fibrosis may be considered as further studies demonstrating efficacy become available.
非酒精性脂肪性肝病（NAFLD）在我们的社会中已达到流行程度，是肝酶升高患者最常见的病因。鉴于出现NAFLD的患者数量众多，区分单纯性脂肪肝和非酒精性脂肪性肝炎（NASH）很重要。虽然一般认为单纯性脂肪肝预后良好，但部分NASH患者可能会进展为肝硬化。对所有NAFLD患者进行肝活检并不可行，但最近的研究已经确定了一些临床因素，这些因素可能预测NASH和晚期纤维化风险最高的患者，因此活检程序可能仅限于符合这些标准的患者。治疗仍然集中在改善大多数患者中始终存在的潜在胰岛素抵抗。饮食和运动仍然是治疗的基石，但随着更多证明疗效的研究出现，可考虑使用胰岛素增敏药物和其他旨在减少氧化应激或纤维化的药物。
