Patel Chavez Chandani, Cusi Kenneth, Kadiyala Sushma
Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL 32610, USA.
Malcom Randall Veteran Administration Medical Center at Gainesville, FL 32610, USA.
J Clin Endocrinol Metab. 2022 Jan 1;107(1):29-38. doi: 10.1210/clinem/dgab578.
The burden of cirrhosis from nonalcoholic fatty liver disease (NAFLD) is reaching epidemic proportions in the United States. This calls for greater awareness among endocrinologists, who often see but may miss the diagnosis in adults with obesity or type 2 diabetes mellitus (T2D) who are at the highest risk. At the same time, recent studies suggest that glucagon-like peptide-1 receptor agonists (GLP-1RAs) are beneficial vs nonalcoholic steatohepatitis (NASH) in this population. This minireview aims to assist endocrinologists to recognize the condition and recent work on the role of GLP-1RAs in NAFLD/NASH.
Evidence from observational studies, randomized controlled trials, and meta-analyses.
Endocrinologists should lead multidisciplinary teams to implement recent consensus statements on NAFLD that call for screening and treatment of clinically significant fibrosis to prevent cirrhosis, especially in the high-risk groups (ie, people with obesity, prediabetes, or T2D). With no US Food and Drug Administration (FDA)-approved agents, weight loss is central to successful management, with pharmacological treatment options limited today to vitamin E (in people without T2D) and diabetes medications that reverse steatohepatitis, such as pioglitazone or GLP-1RA. Recently, the benefit of GLP-1RAs in NAFLD, suggested from earlier trials, has been confirmed in adults with biopsy-proven NASH. In 2021, the FDA also approved semaglutide for obesity management.
A paradigm change is developing between the endocrinologist's greater awareness about their critical role to curve the epidemic of NAFLD and new clinical care pathways that include a broader use of GLP-1RAs in the management of these complex patients.
在美国，非酒精性脂肪性肝病（NAFLD）所致肝硬化的负担正呈流行态势。这就要求内分泌科医生提高认识，因为他们经常会接触到肥胖或2型糖尿病（T2D）的成年患者，而这些患者风险最高，内分泌科医生可能会漏诊。与此同时，近期研究表明，胰高血糖素样肽-1受体激动剂（GLP-1RAs）对该人群的非酒精性脂肪性肝炎（NASH）有益。本综述旨在帮助内分泌科医生认识这种疾病以及GLP-1RAs在NAFLD/NASH中的作用的近期研究进展。
来自观察性研究、随机对照试验和荟萃分析的证据。
内分泌科医生应带领多学科团队实施关于NAFLD的最新共识声明，该声明呼吁对具有临床意义的纤维化进行筛查和治疗以预防肝硬化，尤其是在高危人群（即肥胖、糖尿病前期或T2D患者）中。由于没有美国食品药品监督管理局（FDA）批准的药物，减肥是成功管理的关键，目前药物治疗选择仅限于维生素E（非T2D患者）以及可逆转脂肪性肝炎的糖尿病药物，如吡格列酮或GLP-1RA。最近，早期试验提示的GLP-1RAs对NAFLD的益处已在经活检证实为NASH的成年患者中得到证实。2021年，FDA还批准了司美格鲁肽用于肥胖管理。
内分泌科医生对其在遏制NAFLD流行方面的关键作用的认识不断提高，与新的临床护理途径之间正在发生范式转变，新途径包括在这些复杂患者的管理中更广泛地使用GLP-1RAs。
