Serfaty Lawrence
Hôpital Hautepierre, service d'hépato-gastroentérologie, 1, avenue Molière, 67200 Strasbourg, France; Université Paris Sorbonne, hôpital Saint-Antoine, Inserm UMR-S938, 67000 Strasbourg, France.
Presse Med. 2019 Dec;48(12):1489-1495. doi: 10.1016/j.lpm.2019.09.015. Epub 2019 Nov 19.
Lifestyle modifications, especially weight loss, are efficient on NASH liver injury, however rarely followed in clinical practice. The target population of pharmacologic treatments is represented by patients with NASH and fibrosis. Out of histological improvement, efficacy of treatments should be assessed through liver morbi-mortality benefit, but also on extrahepatic events, such as cardiovascular. Among anti-diabetic treatments, glitazones et GLP-1 agonists have shown efficacy on histological liver injury. Vitamin E is efficient on liver injury but at the cost of prostate cancer and stroke over risk. About 60 new molecules are under investigation in NASH and have 4 different types of mechanism of action: metabolic, oxidative stress/apoptosis, anti inflammatory and anti fibrotic. A phase 3 trial evaluating obeticholic acid have shown a 72 weeks duration treatment improved significantly fibrosis.
生活方式的改变，尤其是体重减轻，对非酒精性脂肪性肝炎（NASH）肝损伤有效，但在临床实践中很少被采用。药物治疗的目标人群是患有NASH和纤维化的患者。除了组织学改善外，治疗效果应通过肝脏病死亡率获益来评估，还应评估肝外事件，如心血管事件。在抗糖尿病治疗中，噻唑烷二酮类药物和胰高血糖素样肽-1（GLP-1）激动剂已显示出对肝脏组织学损伤的疗效。维生素E对肝损伤有效，但会增加前列腺癌和中风的风险代价。目前约有60种新分子正在进行NASH研究，它们有4种不同类型的作用机制：代谢、氧化应激/细胞凋亡、抗炎和抗纤维化。一项评估奥贝胆酸的3期试验表明，72周的治疗显著改善了纤维化。
