Banini Bubu A, Sanyal Arun J
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University Medical Center, Richmond, VA, USA.
Clin Med Insights Ther. 2016;8:75-84. doi: 10.4137/cmt.s18885. Epub 2016 Dec 18.
Nonalcoholic fatty liver disease (NAFLD) is on the rise and has become a major etiology for chronic liver disease. It is frequently associated with obesity, insulin resistance, hypertension, and dyslipidemia and is considered the hepatic manifestation of metabolic syndrome. In this review, we present a summary of the epidemiology and pathogenesis of NAFLD, and discuss the clinical evaluation and stratification of NAFLD patients into low, intermediate, and high risk with respect to liver-related outcomes. While diet and exercise are the cornerstone of treatment in all patients, the low rate of adherence and inadequacy of these recommendations necessitate pharmacologic intervention, especially in intermediate- and high-risk patients. We discuss vitamin E and pioglitazone which are often used as first-line therapy by many practitioners, with pentoxifylline and liraglutide as backup agents. Several drugs are in advanced-phase clinical trials and will likely change the landscape for management of NAFLD in the very near future.
非酒精性脂肪性肝病（NAFLD）的发病率正在上升，已成为慢性肝病的主要病因。它常与肥胖、胰岛素抵抗、高血压和血脂异常相关，被认为是代谢综合征的肝脏表现。在本综述中，我们总结了NAFLD的流行病学和发病机制，并讨论了NAFLD患者在肝脏相关结局方面的临床评估以及分为低、中、高风险的分层。虽然饮食和运动是所有患者治疗的基石，但这些建议的依从率低且不够充分，因此需要药物干预，尤其是在中、高风险患者中。我们讨论了许多从业者经常用作一线治疗的维生素E和吡格列酮，以及作为备用药物的己酮可可碱和利拉鲁肽。几种药物正处于晚期临床试验阶段，很可能在不久的将来改变NAFLD的治疗格局。
