Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.
Institute of Model Animal of Wuhan University, Wuhan, China.
Hepatology. 2019 Oct;70(4):1119-1133. doi: 10.1002/hep.30702.
With rapid lifestyle transitions, the increasing burden of nonalcoholic fatty liver disease (NAFLD) in China has emerged as a major public health issue. To obtain a comprehensive overview of the status of NAFLD over the past decade, we evaluated the epidemiology, risk factors, complications, and management of NAFLD in China through a systematic review and meta-analysis. Five English literature databases and three Chinese databases were searched for relevant topics from 2008 to 2018. A total of 392 studies with a population of 2,054,554 were included. National prevalence of NAFLD was 29.2%, with a heavier disease burden among the middle-aged, males, those in northwest China and Taiwan, regions with a gross domestic product per capita greater than 100,000 yuan, and Uygur and Hui ethnic groups. Currently, original studies on natural history and complications of NAFLD in China are scarce. Several studies revealed that NAFLD is positively correlated with the incidence of extrahepatic tumors, diabetes, cardiovascular disease and metabolic syndrome. The Chinese population may have a higher hereditary risk of NAFLD due to more frequent nonsynonymous mutations in genes regulating lipid metabolism. Ultrasonography is the primary imaging tool in the detection of NAFLD in China. Serum tests and risk stratification algorithms for staging NAFLD remain under investigation. Specific pharmaceutical treatments for NAFLD are still undergoing clinical trials. It is noteworthy that the Chinese are underrepresented compared with their proportion of the NAFLD population in such trials. Conclusion: China experienced an unexpected rapid increase in the burden of NAFLD over a short period. Rising awareness and urgent actions need to be taken in order to control the NAFLD pandemic in China.
随着生活方式的快速转变，非酒精性脂肪性肝病（NAFLD）在中国的负担日益加重，已成为一个主要的公共卫生问题。为了全面了解过去十年中国 NAFLD 的现状，我们通过系统评价和荟萃分析评估了中国 NAFLD 的流行病学、危险因素、并发症和管理。从 2008 年到 2018 年，我们在五个英文文献数据库和三个中文数据库中搜索了相关主题。共纳入 392 项研究，涉及 2054554 人。NAFLD 的全国患病率为 29.2%，中年人群、男性、中国西北地区和台湾地区、人均国内生产总值超过 10 万元的地区、维吾尔族和回族人群的疾病负担更重。目前，中国关于 NAFLD 自然史和并发症的原始研究较少。一些研究表明，NAFLD 与肝外肿瘤、糖尿病、心血管疾病和代谢综合征的发病率呈正相关。由于调节脂质代谢的基因中存在更多的非同义突变，中国人群可能具有更高的 NAFLD 遗传风险。超声检查是中国 NAFLD 检测的主要影像学手段。用于分期 NAFLD 的血清检测和风险分层算法仍在研究中。针对 NAFLD 的特定药物治疗仍在临床试验中。值得注意的是，与 NAFLD 患者的比例相比，中国在这些试验中的代表性不足。结论：中国在短时间内经历了 NAFLD 负担的意外快速增加。为了控制中国的 NAFLD 流行，需要提高认识并采取紧急行动。
