Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna A-1090, Austria.
Cambridge Institute of Therapeutic Immunology and Infectious Disease, Jeffrey Cheah Biomedical Centre, University of Cambridge, Cambridge CB2 0AW, United Kingdom.
World J Gastroenterol. 2021 May 21;27(19):2281-2298. doi: 10.3748/wjg.v27.i19.2281.
The obesity pandemic has led to a significant increase in patients with metabolic dysfunction-associated fatty liver disease (MAFLD). While dyslipidemia, type 2 diabetes mellitus and cardiovascular diseases guide treatment in patients without signs of liver fibrosis, liver related morbidity and mortality becomes relevant for MAFLD's progressive form, non-alcoholic steatohepatitis (NASH), and upon development of liver fibrosis. Statins should be prescribed in patients without significant fibrosis despite concomitant liver diseases but are underutilized in the real-world setting. Bariatric surgery, especially Y-Roux bypass, has been proven to be superior to conservative and/or medical treatment for weight loss and resolution of obesity-associated diseases, but comes at a low but existent risk of surgical complications, reoperations and very rarely, paradoxical progression of NASH. Once end-stage liver disease develops, obese patients benefit from liver transplantation (LT), but may be at increased risk of perioperative infectious complications. After LT, metabolic comorbidities are commonly observed, irrespective of the underlying liver disease, but MAFLD/NASH patients are at even higher risk of disease recurrence. Few studies with low patient numbers evaluated if, and when, bariatric surgery may be an option to avoid disease recurrence but more high-quality studies are needed to establish clear recommendations. In this review, we summarize the most recent literature on treatment options for MAFLD and NASH and highlight important considerations to tailor therapy to individual patient's needs in light of their risk profile.
肥胖症的流行导致代谢功能障碍相关脂肪性肝病（MAFLD）患者显著增加。尽管血脂异常、2 型糖尿病和心血管疾病指导着无肝纤维化迹象患者的治疗，但对于 MAFLD 的进展形式非酒精性脂肪性肝炎（NASH）以及肝纤维化的发生，肝相关发病率和死亡率变得相关。尽管存在伴发肝病，但他汀类药物应在无显著纤维化的患者中开具，而在实际情况下其使用率较低。减重手术，尤其是 Y 型胃旁路术，已被证明在减轻体重和解决肥胖相关疾病方面优于保守和/或药物治疗，但存在较低但存在的手术并发症、再次手术和极少数情况下 NASH 反常进展的风险。一旦发展为终末期肝病，肥胖患者受益于肝移植（LT），但可能会增加围手术期感染并发症的风险。LT 后，无论潜在的肝病如何，都会经常观察到代谢合并症，但 MAFLD/NASH 患者的疾病复发风险更高。少数患者数量较少的研究评估了减重手术是否可能是避免疾病复发的选择，但需要更多高质量的研究来确定明确的建议。在这篇综述中，我们总结了 MAFLD 和 NASH 治疗选择的最新文献，并强调了根据患者的风险状况为个体化患者量身定制治疗的重要考虑因素。
