Division of Internal Medicine, Department of Biomedical, Metabolic and Neural Sciences, Azienda Ospedaliero-Universitaria, Ospedale Civile di Baggiovara, Modena, Italy.
Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
J Hepatol. 2018 Feb;68(2):335-352. doi: 10.1016/j.jhep.2017.09.021. Epub 2017 Nov 6.
Non-alcoholic fatty liver disease (NAFLD) has become one of the most common forms of chronic liver disease worldwide and its prevalence is expected to continue rising. NAFLD has traditionally been considered a consequence of metabolic syndrome (MetS). However, the link between NAFLD and MetS components, especially type 2 diabetes mellitus (T2DM), hypertension (HTN), and cardiovascular disease (CVD) is more complex than previously thought. Indeed, the adverse effects of NAFLD extend far beyond the liver, with a large body of clinical evidence now suggesting that NAFLD may precede and/or promote the development of T2DM, HTN and atherosclerosis/CVD. The risk of developing these cardiometabolic diseases parallels the underlying severity of NAFLD. Accumulating evidence suggests that the presence and severity of NAFLD is associated with an increased risk of incident T2DM and HTN. Moreover, long-term prospective studies indicate that the presence and severity of NAFLD independently predicts fatal and nonfatal CVD events. In this review, we critically discuss the rapidly expanding body of clinical evidence that supports the existence of a bi-directional relationship between NAFLD and various components of MetS, particularly T2DM and HTN, as well as the current knowledge regarding a strong association between NAFLD and CVD morbidity and mortality. Finally, we discuss the most updated putative biological mechanisms through which NAFLD may contribute to the development of HTN, T2DM and CVD.
非酒精性脂肪性肝病（NAFLD）已成为全球最常见的慢性肝病之一，其患病率预计将继续上升。NAFLD 传统上被认为是代谢综合征（MetS）的后果。然而，NAFLD 与 MetS 成分之间的联系，尤其是 2 型糖尿病（T2DM）、高血压（HTN）和心血管疾病（CVD）之间的联系比以前认为的要复杂得多。事实上，NAFLD 的不良影响远不止于肝脏，大量临床证据表明，NAFLD 可能先于和/或促进 T2DM、HTN 和动脉粥样硬化/CVD 的发展。发生这些心血管代谢疾病的风险与 NAFLD 的潜在严重程度平行。越来越多的证据表明，NAFLD 的存在和严重程度与 T2DM 和 HTN 发病风险增加相关。此外，长期前瞻性研究表明，NAFLD 的存在和严重程度独立预测致命和非致命性 CVD 事件。在这篇综述中，我们批判性地讨论了迅速增加的临床证据，这些证据支持 NAFLD 与 MetS 的各种成分之间存在双向关系，特别是 T2DM 和 HTN，以及关于 NAFLD 与 CVD 发病率和死亡率之间存在强烈关联的现有知识。最后，我们讨论了 NAFLD 可能导致 HTN、T2DM 和 CVD 发展的最新推测生物学机制。
