Division of Endocrinology, Department of Medicine, Center of Diabetes Technology, University of Virginia School of Medicine, Charlottesville, VA.
Karsh Division of Gastroenterology and Hepatology, Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA.
Mayo Clin Proc. 2022 Sep;97(9):1700-1716. doi: 10.1016/j.mayocp.2022.04.005.
Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease in the United States and worldwide. The progressive form of NAFLD, nonalcoholic steatohepatitis (NASH), is a leading indication for liver transplant. Comorbidities associated with NAFLD development and NASH include type 2 diabetes, obesity, metabolic syndrome, and dyslipidemia. Extrahepatic morbidity and mortality are considerable as NAFLD is associated with an increased risk of cardiovascular disease and chronic kidney disease. Once NAFLD is diagnosed, the presence of liver fibrosis is the central determinant of hepatic prognosis. Severe liver fibrosis requires aggressive clinical management. No pharmacologic agents have regulatory approval in the United States for the treatment of NAFLD or NASH. Management is centered on efforts to reduce underlying obesity (lifestyle, medications, surgical or endoscopic interventions) and metabolic derangements (prediabetes, type 2 diabetes, hypertension, hyperlipidemia, and others). Current pharmacologic therapy for NAFLD is limited mainly to the use of vitamin E and pioglitazone, although other agents are being investigated in clinical trials. Cardiovascular and metabolic risk factors must also be assessed and managed. Here, NAFLD evaluation, diagnosis, and management are considered in the primary care setting and endocrinology clinics.
非酒精性脂肪性肝病（NAFLD）是美国和全球最常见的慢性肝病病因之一。NAFLD 的进展形式，即非酒精性脂肪性肝炎（NASH），是肝移植的主要指征。与 NAFLD 发生和 NASH 相关的合并症包括 2 型糖尿病、肥胖、代谢综合征和血脂异常。由于 NAFLD 与心血管疾病和慢性肾病的风险增加相关，因此肝外发病率和死亡率相当高。一旦诊断出 NAFLD，肝纤维化的存在是肝脏预后的核心决定因素。严重的肝纤维化需要积极的临床管理。在美国，没有药物获得监管批准用于治疗 NAFLD 或 NASH。治疗的重点是努力减轻潜在的肥胖（生活方式、药物、手术或内镜干预）和代谢紊乱（前驱糖尿病、2 型糖尿病、高血压、血脂异常等）。目前，NAFLD 的药物治疗主要限于使用维生素 E 和吡格列酮，尽管其他药物正在临床试验中进行研究。心血管和代谢危险因素也必须进行评估和管理。在这里，NAFLD 的评估、诊断和管理在初级保健环境和内分泌科诊所中进行考虑。
