Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China.
Liver Research Group, Australian National University Medical School at The Canberra Hospital, Woden, ACT, Australia.
Lancet Gastroenterol Hepatol. 2016 Sep;1(1):56-67. doi: 10.1016/S2468-1253(16)30011-5. Epub 2016 Aug 10.
Non-alcoholic fatty liver disease affects 20-40% of the population. Its active form, non-alcoholic steatohepatitis (NASH), is characterised by hepatocyte injury, liver inflammation, and progression of fibrosis, and has emerged as one of the most important causes of liver failure and hepatocellular carcinoma. Weight reduction of 10% by dietary restriction and regular exercise is sufficient to reverse NASH in most patients, but in practice this reduction is often not achieved. Available drugs such as vitamin E, pioglitazone, and pentoxifylline have borderline efficacy, but are limited by potential side-effects and toxicities, and do not improve liver fibrosis. However, basic and translational research has improved our understanding of the pathophysiology of NASH, thereby identifying several promising new treatment targets. Several drugs are in phase 2 and 3 development and could enter clinical practice in the near future. In this Review, we discuss the pathogenesis, treatment evaluation, existing therapies, and potential new treatments for NASH.
非酒精性脂肪性肝病影响 20-40%的人群。其活动形式，非酒精性脂肪性肝炎（NASH）的特征为肝细胞损伤、肝脏炎症和纤维化进展，已成为肝衰竭和肝细胞癌的最重要原因之一。通过饮食限制和规律运动减轻体重 10%足以使大多数患者的 NASH 逆转，但实际上这种减轻通常无法实现。现有的药物如维生素 E、吡格列酮和己酮可可碱疗效临界，但受潜在副作用和毒性的限制，且不能改善肝纤维化。然而，基础和转化研究提高了我们对 NASH 病理生理学的理解，从而确定了几个有前途的新治疗靶点。几种药物正在进行 2 期和 3 期开发，可能在不久的将来进入临床实践。在这篇综述中，我们讨论了 NASH 的发病机制、治疗评估、现有治疗方法和潜在的新治疗方法。
