Kumar Ramesh, Priyadarshi Rajeev Nayan, Anand Utpal
Department of Gastroenterology, All India Institute of Medical Sciences, Patna, India.
Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, India.
J Clin Transl Hepatol. 2020 Mar 28;8(1):76-86. doi: 10.14218/JCTH.2019.00051. Epub 2019 Dec 28.
Nonalcoholic fatty liver disease (NAFLD) is a systemic disorder with a complex multifactorial pathogenesis and heterogenous clinical manifestations. NAFLD, once believed to be an innocuous condition, has now become the most common cause of chronic liver disease in many countries worldwide. NAFLD is already highly prevalent in the general population, and owing to a rising incidence of obesity and diabetes mellitus, the incidence of NAFLD and its impact on global healthcare are expected to increase in the future. A subset of patients with NAFLD develops progressive liver disease leading to cirrhosis, hepatocellular carcinoma, and liver failure. NAFLD has emerged as one of the leading causes of cirrhosis and hepatocellular carcinoma in recent years. Moreover, HCC can occur in NAFLD even in absence of cirrhosis. Compared with the general population, NAFLD increases the risk of liver-related, cardiovascular and all-cause mortality. NAFLD is bidirectionally associated with metabolic syndrome. NAFLD increases the risk and contributes to aggravation of the pathophysiology of atherosclerosis, cardiovascular diseases, diabetes mellitus, and chronic kidney disease. In addition, NAFLD is linked to colorectal polyps, polycystic ovarian syndrome, osteoporosis, obstructive sleep apnea, stroke, and various extrahepatic malignancies. Extended resection of steatotic liver is associated with increased risk of liver failure and mortality. There is an increasing trend of NAFLD-related cirrhosis requiring liver transplantation, and the recurrence of NAFLD in such patients is almost universal. This review discusses the growing burden of NAFLD, its outcomes, and adverse associations with various diseases.
非酒精性脂肪性肝病（NAFLD）是一种全身性疾病，其发病机制复杂，涉及多因素，临床表现多样。NAFLD曾被认为是一种无害的病症，如今已成为全球许多国家慢性肝病的最常见病因。NAFLD在普通人群中已经非常普遍，由于肥胖症和糖尿病的发病率不断上升，预计未来NAFLD的发病率及其对全球医疗保健的影响将会增加。一部分NAFLD患者会发展为进行性肝病，导致肝硬化、肝细胞癌和肝衰竭。近年来，NAFLD已成为肝硬化和肝细胞癌的主要病因之一。此外，即使没有肝硬化，NAFLD患者也可能发生肝细胞癌。与普通人群相比，NAFLD会增加肝脏相关、心血管和全因死亡的风险。NAFLD与代谢综合征呈双向关联。NAFLD会增加动脉粥样硬化、心血管疾病、糖尿病和慢性肾脏病的发病风险，并促使其病理生理过程恶化。此外，NAFLD还与结肠息肉、多囊卵巢综合征、骨质疏松症、阻塞性睡眠呼吸暂停、中风以及各种肝外恶性肿瘤有关。脂肪变性肝脏的扩大切除术与肝衰竭和死亡风险增加相关。需要肝移植的NAFLD相关肝硬化呈上升趋势，此类患者中NAFLD复发几乎普遍存在。本综述讨论了NAFLD日益加重的负担、其后果以及与各种疾病的不良关联。
