McPherson Stuart, Armstrong Matthew J, Cobbold Jeremy F, Corless Lynsey, Anstee Quentin M, Aspinall Richard J, Barclay Stephen T, Brennan Paul N, Cacciottolo Tessa M, Goldin Robert D, Hallsworth Kate, Hebditch Vanessa, Jack Kathryn, Jarvis Helen, Johnson Jill, Li Wenhao, Mansour Dina, McCallum Mary, Mukhopadhya Ashis, Parker Richard, Ross Valerie, Rowe Ian A, Srivastava Ankur, Thiagarajan Prarthana, Thompson Alexandra I, Tomlinson Jeremy, Tsochatzis Emmanuel A, Yeoman Andrew, Alazawi William
Liver Unit, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
Liver Unit, Queen Elizabeth University Hospital Birmingham NHS Trust, Birmingham, UK; NIHR Biomedical Research Centre, University of Birmingham, Birmingham, UK.
Lancet Gastroenterol Hepatol. 2022 Aug;7(8):755-769. doi: 10.1016/S2468-1253(22)00061-9. Epub 2022 Apr 28.
Non-alcoholic fatty liver disease (NAFLD) is common, affecting approximately 25% of the general population. The evidence base for the investigation and management of NAFLD is large and growing, but there is currently little practical guidance to support development of services and delivery of care. To address this, we produced a series of evidence-based quality standard recommendations for the management of NAFLD, with the aim of improving patient care. A multidisciplinary group of experts from the British Association for the Study of the Liver and British Society of Gastroenterology NAFLD Special Interest Group produced the recommendations, which cover: management of people with, or at risk of, NAFLD before the gastroenterology or liver clinic; assessment and investigations in secondary care; and management in secondary care. The quality of evidence for each recommendation was evaluated by the Grading of Recommendation Assessment, Development and Evaluation tool. An anonymous modified Delphi voting process was conducted individually by each member of the group to assess the level of agreement with each statement. Statements were included when agreement was 80% or greater. From the final list of statements, a smaller number of auditable key performance indicators were selected to allow services to benchmark their practice. It is hoped that services will review their practice against our recommendations and key performance indicators and institute service development where needed to improve the care of patients with NAFLD.
非酒精性脂肪性肝病（NAFLD）很常见，影响着约25%的普通人群。NAFLD调查与管理的证据基础庞大且不断增加，但目前几乎没有实用的指南来支持服务的发展和护理的提供。为解决这一问题，我们制定了一系列基于证据的NAFLD管理质量标准建议，旨在改善患者护理。英国肝脏研究协会和英国胃肠病学会NAFLD特别兴趣小组的多学科专家小组制定了这些建议，内容涵盖：在胃肠病学或肝病诊所就诊前对患有NAFLD或有NAFLD风险者的管理；二级医疗中的评估与检查；以及二级医疗中的管理。每条建议的证据质量通过推荐分级评估、制定与评价工具进行评估。该小组的每位成员分别进行了匿名的改良德尔菲投票过程，以评估对每条陈述的认同程度。当认同度达到80%或更高时，陈述被纳入。从最终的陈述列表中，选择了数量较少的可审计关键绩效指标，以便各服务机构对照自身实践进行基准评估。希望各服务机构对照我们的建议和关键绩效指标审查其实践，并在需要时开展服务改进，以改善NAFLD患者的护理。
