Department of Gastroenterology and Hepatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Liverpool University Hospitals NHS Foundation Trust, University Hospital Aintree, Liverpool, UK.
Diabet Med. 2020 Nov;37(11):1793-1806. doi: 10.1111/dme.14356. Epub 2020 Jul 13.
Non-alcoholic fatty liver disease (NAFLD) exists as a spectrum of disease ranging from excessive accumulation of fat within the liver (simple steatosis), inflammation (non-alcoholic steatohepatitis) through to fibrosis, cirrhosis and end-stage liver disease. There is also an increased risk of hepatocellular carcinoma. The principal risk factor for NAFLD is overweight or obesity, along with type 2 diabetes, and NAFLD itself is also a risk factor for incident type 2 diabetes. Overweight/obesity is synergistic with alcohol consumption in causing progressive and insidious liver damage. Recent consensus advocates a change in nomenclature from NAFLD to 'metabolic associated fatty liver disease' (MAFLD), reflective of the associated metabolic abnormalities (insulin resistance/type 2 diabetes and metabolic syndrome components). Additional extra-hepatic manifestations of NAFLD include cardiovascular disease, chronic kidney disease and certain cancers. Unlike other micro- and macrovascular complications of type 2 diabetes, systematic screening or surveillance protocols have not been widely adopted in routine diabetes care to assess for presence/severity of NAFLD. Various screening tools are available (non-invasive tests and biochemical indices) combined with imaging techniques (e.g. transient elastography) to detect steatosis and more importantly advanced fibrosis/cirrhosis to facilitate appropriate surveillance. Liver biopsy may be sometimes necessary. Treatment options for type 2 diabetes, including lifestyle interventions (dietary change and physical activity), glucose-lowering therapies and metabolic surgery, can modulate hepatic steatosis and to a lesser extent fibrosis. Awareness of the impact of liver disease on the choice of glucose-lowering medications in individuals with type 2 diabetes is also critical.
非酒精性脂肪性肝病（NAFLD）是一种疾病谱，从轻度肝内脂肪堆积（单纯性脂肪变性）、炎症（非酒精性脂肪性肝炎）到纤维化、肝硬化和终末期肝病不等。还存在肝细胞癌风险增加的问题。NAFLD 的主要危险因素是超重或肥胖，以及 2 型糖尿病，而 NAFLD 本身也是 2 型糖尿病发病的一个危险因素。超重/肥胖与饮酒一起导致逐渐加重和隐匿性肝损伤具有协同作用。最近的共识提倡将命名从 NAFLD 改为“代谢相关脂肪性肝病”（MAFLD），反映了相关的代谢异常（胰岛素抵抗/2 型糖尿病和代谢综合征成分）。NAFLD 的其他肝外表现包括心血管疾病、慢性肾脏病和某些癌症。与 2 型糖尿病的其他微血管和大血管并发症不同，系统筛查或监测方案尚未在常规糖尿病护理中广泛采用，以评估是否存在/严重程度的 NAFLD。有多种筛查工具（非侵入性检查和生化指标）与影像学技术（如瞬时弹性成像）相结合，可用于检测脂肪变性，更重要的是检测晚期纤维化/肝硬化，以促进适当的监测。有时可能需要进行肝活检。2 型糖尿病的治疗选择，包括生活方式干预（饮食改变和体育活动）、降血糖治疗和代谢手术，可以调节肝脂肪变性，并在较小程度上调节纤维化。了解肝脏疾病对 2 型糖尿病患者选择降血糖药物的影响也至关重要。
