Nemes Katriina, Åberg Fredrik
aUniversity of Helsinki and Helsinki University Central Hospital, Department of Transplantation and Liver Surgery, Helsinki, Finland bUniversity of Helsinki and Helsinki University Central Hospital, Department of Internal Medicine, Helsinki, Finland.
Curr Opin Lipidol. 2017 Aug;28(4):355-360. doi: 10.1097/MOL.0000000000000427.
The pathophysiologies of nonalcoholic fatty liver disease (NAFLD), metabolic syndrome, and cardiovascular disease are closely interlinked and associated with atherogenic dyslipidemia. Liver and cardiovascular disease may silently progress to advanced stages if alarming signs, such as abdominal obesity, elevated fasting and postprandial triglycerides, and low HDL cholesterol are overlooked. We review the metabolic mechanisms in NAFLD at the cellular level in the context of standard clinical lipid measurements.
We discuss the pathogenesis of NAFLD, nonalcoholic steatohepatitis (NASH), and metabolic syndrome, atherogenic dyslipidemia, lipotoxicity, and lipophagy.
Physicians should infer from biomarkers or clinical findings that their abdominally obese patients are at risk of severe cardiovascular, liver fatty disease, or both. Physicians should carry out laboratory tests of plasma cholesterol, triglycerides, LDL and HDL cholesterol, non-HDL cholesterol, apolipoprotein B and platelets, and for diabetes, but importantly, plasma triglycerides also in the nonfasting state. But note, clinical routine plasma lipid and lipoprotein measurements are not necessarily reliable for interpreting severe metabolic changes. Notably, in advanced stages of NAFLD (i.e., late steatohepatitis and cirrhosis), routine lipid profiles do not necessarily show any more abnormalities.
非酒精性脂肪性肝病（NAFLD）、代谢综合征和心血管疾病的病理生理学密切相关，并与致动脉粥样硬化性血脂异常有关。如果忽视诸如腹型肥胖、空腹和餐后甘油三酯升高以及高密度脂蛋白胆固醇降低等警示信号，肝脏和心血管疾病可能会悄然发展至晚期。我们结合标准临床血脂测量，在细胞水平上综述NAFLD的代谢机制。
我们讨论了NAFLD、非酒精性脂肪性肝炎（NASH）、代谢综合征、致动脉粥样硬化性血脂异常、脂毒性和脂肪自噬的发病机制。
医生应从生物标志物或临床发现推断，腹型肥胖患者有患严重心血管疾病、肝脏脂肪性疾病或两者兼有的风险。医生应进行血浆胆固醇、甘油三酯、低密度脂蛋白和高密度脂蛋白胆固醇、非高密度脂蛋白胆固醇、载脂蛋白B和血小板的实验室检测以及糖尿病检测，但重要的是，也要检测非空腹状态下的血浆甘油三酯。但请注意，临床常规血浆脂质和脂蛋白测量对于解释严重代谢变化不一定可靠。值得注意的是，在NAFLD的晚期阶段（即晚期脂肪性肝炎和肝硬化），常规血脂谱不一定会显示出更多异常。
