非酒精性脂肪性肝病与初级保健和二级保健之间的关系。
Non-alcoholic fatty liver disease and the interface between primary and secondary care.
机构信息
Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital and University College London, London, UK.
National Institute for Health Research, Liver Biomedical Research Unit and Liver Unit, University Hospitals Birmingham NHS Foundation Trust and Centre for Liver Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
出版信息
Lancet Gastroenterol Hepatol. 2018 Jul;3(7):509-517. doi: 10.1016/S2468-1253(18)30077-3.
Non-alcoholic fatty liver disease (NAFLD) has a prevalence of 25-30% in unselected populations and has become the main reason for referrals to hepatology services. From the perspective of liver disease, NAFLD has a high prevalence but low severity. Screening studies in people at risk for NAFLD have shown a prevalence of advanced fibrosis of 5%, which underlines the need for robust pathways for risk stratification in primary care, with subsequent referrals as required. In this Review, we discuss the interface between primary and secondary care with regards to risk stratification and management of patients with NAFLD. We focus on selected issues of epidemiology and natural history and discuss the burden of disease in primary care, the evidence on screening for NAFLD, the rationale for testing for advanced fibrosis, and the optimal management of the disease in primary care.
非酒精性脂肪性肝病（NAFLD）在未选择的人群中的患病率为 25-30%，已成为向肝病科就诊的主要原因。从肝病的角度来看，NAFLD 的患病率高，但严重程度低。对有患 NAFLD 风险的人群进行的筛查研究显示，晚期纤维化的患病率为 5%，这强调了在初级保健中需要建立稳健的风险分层途径，并根据需要进行后续转诊。在这篇综述中，我们讨论了初级保健和二级保健在 NAFLD 患者的风险分层和管理方面的接口。我们重点讨论了流行病学和自然史的一些选定问题，并讨论了初级保健中疾病的负担、NAFLD 筛查的证据、检测晚期纤维化的理由，以及初级保健中该疾病的最佳管理。
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