Kosmalski Marcin, Mokros Łukasz, Kuna Piotr, Witusik Andrzej, Pietras Tadeusz
Department of Clinical Pharmacology, Medical University of Lodz, Poland.
Department of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Poland.
Cent Eur J Immunol. 2018;43(2):231-239. doi: 10.5114/ceji.2018.77395. Epub 2018 Jun 30.
Non-alcoholic fatty liver disease (NAFLD) is one of the most common pathologies of that organ. The development of the disease involves a variety of mechanisms, including insulin resistance, oxidative stress, endoplasmic reticulum stress, endotoxins from the intestinal flora and genetic predispositions. Additionally, clinical data suggest that the presence of NAFLD is associated with excessive activation of the immune system. For practical purposes, attention should be paid to the moment when the subjects predisposed to NAFLD develop inflammatory infiltration and signs of fibrosis in the liver (non-alcoholic steatohepatitis - NASH). Their presence is an important risk factor for hepatic cirrhosis, hepatic failure, and hepatocellular carcinoma, as well as for the occurrence of cardiovascular events. Regardless of the diagnostic methods used, including laboratory tests and imaging, liver biopsy remains the gold standard to identify and differentiate patients with NAFLD and NASH. The search for other, safer, cheaper and more readily available diagnostic tests is still being continued. Attention has been drawn to the usefulness of markers of immune status of the organism, not only for the diagnosis of NASH, but also for the identification of NAFLD patients at risk of disease progression. Despite the effectiveness of medication, no recommendations have been established for pharmacotherapy of NAFLD. Data indicate the primary need for non-pharmacological interventions to reduce body weight. However, there is evidence of the applicability of certain drugs and dietary supplements, which, by their effect on the immune system, inhibit its excessive activity, thus preventing the progression of NAFLD to NASH.
非酒精性脂肪性肝病（NAFLD）是该器官最常见的病变之一。该疾病的发展涉及多种机制，包括胰岛素抵抗、氧化应激、内质网应激、肠道菌群产生的内毒素以及遗传易感性。此外，临床数据表明，NAFLD的存在与免疫系统的过度激活有关。出于实际目的，应关注易患NAFLD的受试者肝脏出现炎症浸润和纤维化迹象（非酒精性脂肪性肝炎 - NASH）的时刻。它们的存在是肝硬化、肝衰竭、肝细胞癌以及心血管事件发生的重要危险因素。无论使用何种诊断方法，包括实验室检查和影像学检查，肝活检仍然是识别和区分NAFLD和NASH患者的金标准。寻找其他更安全、更便宜且更易于获得的诊断测试仍在继续。人们已经注意到机体免疫状态标志物的有用性，不仅用于诊断NASH，还用于识别有疾病进展风险的NAFLD患者。尽管药物有效，但尚未建立NAFLD药物治疗的推荐方案。数据表明首要需要进行非药物干预以减轻体重。然而，有证据表明某些药物和膳食补充剂具有适用性，它们通过对免疫系统的作用抑制其过度活动，从而防止NAFLD进展为NASH。
