Elhence Anshuman
Department of Gastroenterology, All India Institute of Medical Sciences, Room No 127, 1st Floor, Human Nutrition Unit, New Delhi, 110 029, India.
Indian J Gastroenterol. 2020 Feb;39(1):22-31. doi: 10.1007/s12664-020-01021-2. Epub 2020 Mar 9.
Therapeutics aimed at treating non-alcoholic fatty liver disease (NAFLD) target the pathogenic process from deranged metabolism leading to steatosis to cell stress and death, leading to a cascade of inflammation and fibrosis, ultimately culminating into cirrhosis. The development of drugs for management of NAFLD has bloomed over the past decade, although at present there is no approved pharmacological agent for its management. Not all patients with the disease progress to cirrhosis and decompensation; hence, treatment specifically is provided for those with a high risk of progression such as those with biopsy-proven steatohepatitis or fibrosis. Along with disease-specific management, all patients must receive therapies directed at risk factors such as dyslipidemia, insulin resistance, type 2 diabetes mellitus and obesity. Comorbidities such as cardiovascular disease, sleep apnoea and chronic kidney disease need management. A current perspective on the therapeutic options is detailed in this review.
旨在治疗非酒精性脂肪性肝病(NAFLD)的疗法针对的是从代谢紊乱导致脂肪变性到细胞应激和死亡的致病过程,进而引发一系列炎症和纤维化,最终发展为肝硬化。在过去十年中,用于管理NAFLD的药物研发蓬勃发展,尽管目前尚无获批用于其管理的药物。并非所有该疾病患者都会进展为肝硬化和失代偿;因此,专门针对那些进展风险高的患者进行治疗,例如经活检证实为脂肪性肝炎或纤维化的患者。除了针对疾病的管理外,所有患者都必须接受针对血脂异常、胰岛素抵抗、2型糖尿病和肥胖等危险因素的治疗。心血管疾病、睡眠呼吸暂停和慢性肾脏病等合并症也需要进行管理。本综述详细介绍了当前关于治疗选择的观点。