非酒精性脂肪性肝病与肥胖症治疗。
Nonalcoholic Fatty Liver Disease and Obesity Treatment.
机构信息
Section of Gastroenterology, Boston Medical Center, Boston University School of Medicine, 85 East Concord Street 7th Floor, Boston, MA, 02118, USA.
Boston University School of Medicine, Boston, MA, USA.
出版信息
Curr Obes Rep. 2019 Sep;8(3):220-228. doi: 10.1007/s13679-019-00345-1.
PURPOSE OF REVIEW
Nonalcoholic fatty liver disease (NAFLD), the most prevalent cause of chronic liver disease worldwide, is strongly associated with obesity and insulin resistance.
RECENT FINDINGS
Significant weight loss can improve NAFLD and nonalcoholic steatohepatitis (NASH). Diet and exercise that result in a sustained body weight reduction of 7-10% can improve liver fat content, NASH, and fibrosis. Vitamin E can be considered in patients with biopsy-proven NASH without diabetes, though caution must be used in those with prostate cancer. Pioglitazone improves liver histology, including fibrosis, and can be considered in patients with or without diabetes. Glucagon-like peptide-1 (GLP-1) antagonists may be beneficial in NASH, but more studies are needed before they can be recommended. Bariatric surgery, with resultant weight loss, can result in improvement in liver fat and inflammation. NAFLD treatment includes diet and exercise with a target 7-10% weight reduction. Treatment goals include improvements in liver fat content, liver inflammation, and fibrosis.
目的综述
非酒精性脂肪性肝病（NAFLD）是世界范围内最常见的慢性肝病病因，与肥胖和胰岛素抵抗密切相关。
最新发现
显著的体重减轻可以改善非酒精性脂肪性肝病和非酒精性脂肪性肝炎（NASH）。饮食和运动导致持续体重减轻 7-10%，可以改善肝脂肪含量、NASH 和纤维化。对于有活检证实的 NASH 而没有糖尿病的患者，可以考虑使用维生素 E，但对于有前列腺癌的患者必须谨慎使用。吡格列酮可改善肝组织学，包括纤维化，可用于治疗有或没有糖尿病的患者。胰高血糖素样肽-1（GLP-1）拮抗剂在 NASH 中可能有益，但需要更多的研究才能推荐。减重手术可导致体重减轻，从而改善肝脏脂肪和炎症。NAFLD 的治疗包括饮食和运动，目标是减轻 7-10%的体重。治疗目标包括改善肝脂肪含量、肝炎症和纤维化。
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