Bica Cristina, Sandu Camelia, Suceveanu Andra Iulia, Sarbu Eliza, Stoica Roxana Adriana, Gherghiceanu Florentina, Bohiltea Roxana Elena, Stefan Simona Diana, Stoian Anca Pantea
National Institute of Diabetes, Nutrition and Metabolic Diseases 'Prof. N.C. Paulescu', 020475 Bucharest, Romania.
Faculty of Medicine, Ovidius University, 900470 Constanta, Romania.
Exp Ther Med. 2020 Sep;20(3):2387-2391. doi: 10.3892/etm.2020.8882. Epub 2020 Jun 12.
Non-alcoholic fatty liver disease (NAFLD) has a high prevalence in type 2 diabetes mellitus (T2DM) patients, being one of the disorders with a relevant global burden. Cross-sectional studies have shown that patients with T2DM and NAFLD have a higher prevalence of liver fibrosis, compared with the general population. Patients with non-alcoholic steatohepatitis (NASH) and T2DM have an increased mortality and morbidity, therefore they generate substantial health care costs. NASH worsens chronic diabetes complications, and T2DM aggravate the NASH progression to fibrosis, cirrhosis, and even hepatocellular carcinoma (HCC). The objectives in NAFLD and NASH therapy are to reduce disease activity, to slow down progression of fibrosis, and to lower the risk factors. Unfortunately, there are no specific validated pharmacological therapies. Several trials have demonstrated that anti-diabetic agents such as thiazolidindiones, sodium-glucose co-transporter inhibitors, glucagon like peptide-1 receptor analogs, or dipeptidyl peptidase-4 inhibitors might have complimentary benefits for patients with NAFLD. Some of the effect on reducing steatosis and fibrosis is explained by the weight loss these treatments produce. A goal in standard care is developing screening tools, early and non-invasive diagnosis methods, studying the pleiotropic effects of drugs, together with newer therapeutic agents, which can target mutual pathogenic mechanisms for diabetes and liver disease.
非酒精性脂肪性肝病（NAFLD）在2型糖尿病（T2DM）患者中具有较高的患病率，是一种具有重大全球负担的疾病。横断面研究表明，与普通人群相比，T2DM和NAFLD患者肝纤维化的患病率更高。非酒精性脂肪性肝炎（NASH）和T2DM患者的死亡率和发病率增加，因此会产生大量医疗费用。NASH会加重慢性糖尿病并发症，而T2DM会加速NASH向纤维化、肝硬化甚至肝细胞癌（HCC）的进展。NAFLD和NASH治疗的目标是降低疾病活动度、减缓纤维化进展并降低危险因素。不幸的是，目前尚无经过验证的特异性药物治疗方法。多项试验表明，噻唑烷二酮类、钠-葡萄糖协同转运蛋白抑制剂、胰高血糖素样肽-1受体类似物或二肽基肽酶-4抑制剂等抗糖尿病药物可能对NAFLD患者有辅助益处。这些治疗带来的体重减轻解释了其对减少脂肪变性和纤维化的部分作用。标准治疗的一个目标是开发筛查工具、早期和非侵入性诊断方法，研究药物的多效性作用，以及可针对糖尿病和肝病共同致病机制的新型治疗药物。
