非酒精性脂肪性肝病/非酒精性脂肪性肝炎的自然史
Natural History of NAFLD/NASH.
作者信息
Ekstedt Mattias, Nasr Patrik, Kechagias Stergios
机构信息
Department of Gastroenterology and Hepatology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
出版信息
Curr Hepatol Rep. 2017;16(4):391-397. doi: 10.1007/s11901-017-0378-2. Epub 2017 Nov 13.
Abstract
PURPOSE OF REVIEW
The purpose of this review is to summarize the latest knowledge on the natural history of non-alcoholic fatty liver disease (NAFLD). The review focuses on mortality, liver-related complications, and histological course.
RECENT FINDINGS
Studies during the last decade have established NAFLD as a potentially progressive liver disease. Age and diabetes are the strongest clinical predictors of progressive disease. Fibrosis stage is the most important histological variable to predict mortality and liver-related complications. So far, no study has been able to show that non-alcoholic steatohepatitis at baseline predicts mortality or future liver-related complications when adjusting for fibrosis.
SUMMARY
The outlines of the natural history of NAFLD have become clearer during the last decade. There is limited data on factors that predict clinical progression. Prospective longitudinal studies are needed to help us predict worse outcome in individual patients.
摘要
综述目的
本综述旨在总结非酒精性脂肪性肝病（NAFLD）自然史的最新知识。该综述聚焦于死亡率、肝脏相关并发症及组织学病程。
最新发现
过去十年的研究已证实NAFLD是一种潜在进展性肝病。年龄和糖尿病是疾病进展最强的临床预测因素。纤维化阶段是预测死亡率和肝脏相关并发症最重要的组织学变量。迄今为止，尚无研究能够表明，在校正纤维化因素后，基线时的非酒精性脂肪性肝炎可预测死亡率或未来肝脏相关并发症。
总结
在过去十年中，NAFLD自然史的轮廓已变得更加清晰。预测临床进展的因素数据有限。需要开展前瞻性纵向研究，以帮助我们预测个体患者的不良结局。
相似文献
1
Natural History of NAFLD/NASH.非酒精性脂肪性肝病/非酒精性脂肪性肝炎的自然史
Curr Hepatol Rep. 2017;16(4):391-397. doi: 10.1007/s11901-017-0378-2. Epub 2017 Nov 13.
2
Fibrosis stage but not NASH predicts mortality and time to development of severe liver disease in biopsy-proven NAFLD.纤维化分期而非 NASH 可预测经活检证实的非酒精性脂肪性肝病患者的死亡率和严重肝脏疾病的发生时间。
J Hepatol. 2017 Dec;67(6):1265-1273. doi: 10.1016/j.jhep.2017.07.027. Epub 2017 Aug 10.
3
Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults.系统评价：成人非酒精性脂肪性肝病和非酒精性脂肪性肝炎的流行病学和自然史。
Aliment Pharmacol Ther. 2011 Aug;34(3):274-85. doi: 10.1111/j.1365-2036.2011.04724.x. Epub 2011 May 30.
4
Single non-invasive model to diagnose non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH).用于诊断非酒精性脂肪性肝病（NAFLD）和非酒精性脂肪性肝炎（NASH）的单一非侵入性模型。
J Gastroenterol Hepatol. 2014 Dec;29(12):2006-13. doi: 10.1111/jgh.12665.
5
The use of statins alone, or in combination with pioglitazone and other drugs, for the treatment of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis and related cardiovascular risk. An Expert Panel Statement.他汀类药物单独使用，或与吡格列酮及其他药物联合使用，用于治疗非酒精性脂肪性肝病/非酒精性脂肪性肝炎及相关心血管风险。专家小组声明。
Metabolism. 2017 Jun;71:17-32. doi: 10.1016/j.metabol.2017.02.014. Epub 2017 Mar 4.
6
Meta-analysis: natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity.荟萃分析：非酒精性脂肪性肝病（NAFLD）自然史及肝疾病严重程度无创性检测的诊断准确性。
Ann Med. 2011 Dec;43(8):617-49. doi: 10.3109/07853890.2010.518623. Epub 2010 Nov 2.
7
Prevalence and Predictors of Non-Alcoholic Fatty Liver Disease in Morbidly Obese South Indian Patients Undergoing Bariatric Surgery.接受减肥手术的重度肥胖南印度患者中非酒精性脂肪性肝病的患病率及预测因素
Obes Surg. 2015 Nov;25(11):2078-87. doi: 10.1007/s11695-015-1655-1.
8
Treatment of patients with type 2 diabetes and non-alcoholic fatty liver disease: current approaches and future directions.2型糖尿病合并非酒精性脂肪性肝病患者的治疗：当前方法与未来方向
Diabetologia. 2016 Jun;59(6):1112-20. doi: 10.1007/s00125-016-3952-1. Epub 2016 Apr 21.
9
Prospective evaluation of the prevalence of non-alcoholic fatty liver disease and steatohepatitis in a large middle-aged US cohort.前瞻性评估大型美国中年队列中非酒精性脂肪性肝病和脂肪性肝炎的患病率。
J Hepatol. 2021 Aug;75(2):284-291. doi: 10.1016/j.jhep.2021.02.034. Epub 2021 Mar 18.
10
Evidence of NAFLD progression from steatosis to fibrosing-steatohepatitis using paired biopsies: implications for prognosis and clinical management.使用配对活检评估非酒精性脂肪性肝病从脂肪变性进展为纤维性脂肪性肝炎的证据：对预后和临床管理的影响。
J Hepatol. 2015 May;62(5):1148-55. doi: 10.1016/j.jhep.2014.11.034. Epub 2014 Dec 1.
引用本文的文献
1
Increased serum uric acid to creatinine ratio is associated with metabolic dysfunction associated steatotic liver disease.血清尿酸与肌酐比值升高与代谢功能障碍相关脂肪性肝病有关。
Sci Rep. 2025 Jul 24;15(1):26941. doi: 10.1038/s41598-025-09073-0.
2
Hepatic stellate cell inhibition by angiotensin II receptor blocker mitigates liver injury and fibrosis via NF-κB-galectin-3 suppression in a rat nonalcoholic steatohepatitis model.在大鼠非酒精性脂肪性肝炎模型中，血管紧张素II受体阻滞剂对肝星状细胞的抑制作用通过抑制NF-κB-半乳糖凝集素-3减轻肝损伤和肝纤维化。
Arch Toxicol. 2025 Jun 9. doi: 10.1007/s00204-025-04075-3.
3
Associations of lower values of peak oxygen uptake and handgrip strength with a smaller liver volume.峰值摄氧量和握力较低值与较小肝脏体积之间的关联。
Ups J Med Sci. 2025 May 16;130. doi: 10.48101/ujms.v130.11924. eCollection 2025.
4
Unraveling MASLD: The Role of Gut Microbiota, Dietary Modulation, and AI-Driven Lifestyle Interventions.解析代谢相关脂肪性肝病：肠道微生物群、饮食调节及人工智能驱动的生活方式干预的作用
Nutrients. 2025 May 4;17(9):1580. doi: 10.3390/nu17091580.
5
Enpp1 ameliorates MAFLD by regulating hepatocyte lipid metabolism through the AMPK/PPARα signaling pathway.Enpp1通过AMPK/PPARα信号通路调节肝细胞脂质代谢来改善MAFLD。
Cell Biosci. 2025 Feb 19;15(1):22. doi: 10.1186/s13578-025-01364-3.
6
Similar weight loss with semaglutide regardless of diabetes and cardiometabolic risk parameters in individuals with metabolic dysfunction-associated steatotic liver disease: Post hoc analysis of three randomised controlled trials.在患有代谢功能障碍相关脂肪性肝病的个体中，无论糖尿病和心脏代谢风险参数如何，司美格鲁肽均可带来相似的体重减轻：三项随机对照试验的事后分析
Diabetes Obes Metab. 2025 Feb;27(2):710-718. doi: 10.1111/dom.16065. Epub 2024 Nov 28.
7
Global Trends and Inequalities of Liver Complications Related to Metabolic Dysfunction-Associated Steatotic Liver Disease: An Analysis From 1990 to 2021.与代谢功能障碍相关脂肪性肝病相关肝脏并发症的全球趋势及不平等现象：1990年至2021年的分析
Liver Int. 2025 Apr;45(4):e16120. doi: 10.1111/liv.16120. Epub 2024 Oct 10.
8
Exploration of Latina/Hispanic women's experiences living with non-alcoholic fatty liver disease: a qualitative study with patients in Houston.拉丁裔/西班牙裔妇女非酒精性脂肪性肝病生活体验探索：休斯顿患者的定性研究。
BMJ Open. 2024 Mar 15;14(3):e084411. doi: 10.1136/bmjopen-2024-084411.
9
Effects of Interventions for Improving Awareness and Knowledge of Nonalcoholic Fatty Liver Disease Among Chinese Young Adults for Prevention of Liver Cancer-A Randomized Controlled Trial.改善中国青年人群对非酒精性脂肪性肝病的认知和知识以预防肝癌的干预措施的效果：一项随机对照试验。
J Cancer Educ. 2024 Jun;39(3):253-263. doi: 10.1007/s13187-024-02404-1. Epub 2024 Mar 2.
10
Effect of Intermittent Fasting on Lipid Profile, Anthropometric and Hepatic Markers in Non-Alcoholic Fatty Liver Disease (NAFLD): A Systematic Review.间歇性禁食对非酒精性脂肪性肝病（NAFLD）患者血脂谱、人体测量学和肝脏标志物的影响：系统评价。
Curr Vasc Pharmacol. 2024;22(3):187-202. doi: 10.2174/0115701611285401240110074530.
本文引用的文献
1
Fibrosis stage but not NASH predicts mortality and time to development of severe liver disease in biopsy-proven NAFLD.纤维化分期而非 NASH 可预测经活检证实的非酒精性脂肪性肝病患者的死亡率和严重肝脏疾病的发生时间。
J Hepatol. 2017 Dec;67(6):1265-1273. doi: 10.1016/j.jhep.2017.07.027. Epub 2017 Aug 10.
2
Ultrasonographic fatty liver indicator detects mild steatosis and correlates with metabolic/histological parameters in various liver diseases.超声脂肪肝指标可检测轻度脂肪变性，并与各种肝脏疾病的代谢/组织学参数相关。
Metabolism. 2017 Jul;72:57-65. doi: 10.1016/j.metabol.2017.04.003. Epub 2017 Apr 13.
3
Comparison of laboratory tests, ultrasound, or magnetic resonance elastography to detect fibrosis in patients with nonalcoholic fatty liver disease: A meta-analysis.比较实验室检查、超声或磁共振弹性成像在非酒精性脂肪性肝病患者中检测纤维化的价值：一项荟萃分析。
Hepatology. 2017 Nov;66(5):1486-1501. doi: 10.1002/hep.29302. Epub 2017 Sep 26.
4
Histologic Scores for Fat and Fibrosis Associate With Development of Type 2 Diabetes in Patients With Nonalcoholic Fatty Liver Disease.组织学评分中脂肪和纤维化与非酒精性脂肪性肝病患者 2 型糖尿病的发生相关。
Clin Gastroenterol Hepatol. 2017 Sep;15(9):1461-1468. doi: 10.1016/j.cgh.2017.04.040. Epub 2017 May 4.
5
How healthy are the "Healthy volunteers"? Penetrance of NAFLD in the biomedical research volunteer pool.“健康志愿者”有多健康？非酒精性脂肪性肝病在生物医学研究志愿者群体中的患病率。
Hepatology. 2017 Sep;66(3):825-833. doi: 10.1002/hep.29247. Epub 2017 Jul 27.
6
Using a 3% Proton Density Fat Fraction as a Cut-Off Value Increases Sensitivity of Detection of Hepatic Steatosis, Based on Results From Histopathology Analysis.基于组织病理学分析结果，使用 3% 的质子密度脂肪分数作为截断值可提高肝脂肪变性的检测灵敏度。
Gastroenterology. 2017 Jul;153(1):53-55.e7. doi: 10.1053/j.gastro.2017.03.005. Epub 2017 Mar 9.
7
Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: Systematic review and meta-analysis.非酒精性脂肪性肝病中纤维化阶段导致的死亡风险增加：系统评价与荟萃分析
Hepatology. 2017 May;65(5):1557-1565. doi: 10.1002/hep.29085. Epub 2017 Mar 31.
8
Association of non-alcoholic fatty liver disease with major adverse cardiovascular events: A systematic review and meta-analysis.非酒精性脂肪性肝病与主要不良心血管事件的关联：系统评价和荟萃分析。
Sci Rep. 2016 Sep 16;6:33386. doi: 10.1038/srep33386.
9
SAF score and mortality in NAFLD after up to 41 years of follow-up.长达41年随访后非酒精性脂肪性肝病的SAF评分与死亡率
Scand J Gastroenterol. 2017 Jan;52(1):87-91. doi: 10.1080/00365521.2016.1230779. Epub 2016 Sep 10.
10
Nonobese Fatty Liver Disease.非肥胖性脂肪肝疾病。
Clin Gastroenterol Hepatol. 2017 Apr;15(4):474-485. doi: 10.1016/j.cgh.2016.08.028. Epub 2016 Aug 28.
Zotero 插件