Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
J Intern Med. 2022 Aug;292(2):190-204. doi: 10.1111/joim.13531. Epub 2022 Jul 7.
Non-alcoholic fatty liver disease (NAFLD) comprises a wide spectrum of pathologies ranging from non-alcoholic fatty liver (NAFL), characterized by simple steatosis without inflammation, to non-alcoholic steatohepatitis (NASH), characterized by steatosis of the liver accompanied by inflammation and hepatocyte ballooning, which can lead to advanced fibrosis, cirrhosis and hepatocellular carcinoma. Apart from lifestyle modifications such as weight loss, a Mediterranean diet and physical activity, only a few NAFLD-specific pharmacological treatment options such as Vitamin E and Pioglitazone are considered by current international guidelines. However, recently randomized controlled trials with GLP-1 agonists, FXR and PPAR ligands as well as other agents have been published and may expand the therapeutic armamentarium for NAFLD in the near future. Finally, knowledge about treating complications of end-stage liver disease due to NASH becomes an increasingly important cornerstone in the treatment of the broad disease spectrum of NAFLD. In this review, we summarize currently available and future treatment options for patients with NAFLD that may help internal medicine specialists treat the complete clinical spectrum of this highly prevalent liver disease.
非酒精性脂肪性肝病（NAFLD）包括一系列广泛的病理学改变，从轻度非酒精性脂肪肝（NAFL），其特征为单纯性脂肪变性而无炎症，到非酒精性脂肪性肝炎（NASH），其特征为肝脏脂肪变性伴炎症和肝细胞气球样变，可导致进展性肝纤维化、肝硬化和肝细胞癌。除了生活方式改变，如减肥、地中海饮食和体育活动，目前国际指南仅考虑少数几种针对 NAFLD 的特定药物治疗选择，如维生素 E 和吡格列酮。然而，最近发表了 GLP-1 激动剂、FXR 和 PPAR 配体以及其他药物的随机对照试验，可能在不久的将来扩大 NAFLD 的治疗手段。最后，由于 NASH 导致的终末期肝病并发症的治疗知识成为治疗 NAFLD 这一广泛疾病谱的重要基石。在这篇综述中，我们总结了目前可用于治疗 NAFLD 患者的方法，这些方法可能有助于内科医生治疗这种高度流行的肝病的完整临床谱。
