Sayiner Mehmet, Lam Brian, Golabi Pegah, Younossi Zobair M
Department of Medicine, Inova Fairfax Hospital, Falls Church, VA.
Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA.
Therap Adv Gastroenterol. 2018 Nov 15;11:1756284818811508. doi: 10.1177/1756284818811508. eCollection 2018.
Nonalcoholic fatty liver disease (NAFLD) is rapidly becoming the most common type of chronic liver disease worldwide. From the spectrum of NAFLD, it is nonalcoholic steatohepatitis (NASH) that predominantly predisposes patients to higher risk for development of cirrhosis and hepatocellular carcinoma. There is growing evidence that the risk of progression to cirrhosis and hepatocellular carcinoma is not uniform among all patients with NASH. In fact, NASH patients with increasing numbers of metabolic diseases such as diabetes, hypertension, visceral obesity and dyslipidemia are at a higher risk of mortality. Additionally, patients with higher stage of liver fibrosis are also at increased risk of mortality. In this context, NASH patients with fibrosis are in the most urgent need of treatment. Also, the first line of treatment for NASH is lifestyle modification with diet and exercise. Nevertheless, the efficacy of lifestyle modification is quite limited. Additionally, vitamin E and pioglitazone may be considered for subset of patients with NASH. There are various medications targeting one or more steps in the pathogenesis of NASH being developed. These drug regimens either alone or in combination, may provide potential treatment option for patients with NASH.
非酒精性脂肪性肝病（NAFLD）正迅速成为全球最常见的慢性肝病类型。在NAFLD的范围内，主要是非酒精性脂肪性肝炎（NASH）使患者更容易发展为肝硬化和肝细胞癌。越来越多的证据表明，并非所有NASH患者进展为肝硬化和肝细胞癌的风险都是一致的。事实上，患有越来越多代谢性疾病（如糖尿病、高血压、内脏肥胖和血脂异常）的NASH患者死亡风险更高。此外，肝纤维化程度较高的患者死亡风险也会增加。在这种情况下，有纤维化的NASH患者最急需治疗。而且，NASH的一线治疗是通过饮食和运动进行生活方式的改变。然而，生活方式改变的疗效相当有限。此外，对于一部分NASH患者，可以考虑使用维生素E和吡格列酮。目前正在研发针对NASH发病机制中一个或多个步骤的各种药物。这些药物方案单独使用或联合使用，可能为NASH患者提供潜在的治疗选择。
