Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service d'hepato-gastroentérologie, Hôpital Pitié-Salpêtrière, Paris, France.
Department of Endocrinology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Roumanie.
Hepatology. 2024 Nov 1;80(5):1270-1290. doi: 10.1097/HEP.0000000000000456. Epub 2023 May 16.
Despite the slow, progressive nature of NAFLD, the number of patients with NAFLD-related cirrhosis has significantly increased. Although the management of patients with cirrhosis is constantly evolving, improving the prognosis of patients with NAFLD-related cirrhosis is a challenge because it is situated at the crossroads between the liver, the metabolic, and the cardiovascular diseases. Therefore, the therapeutic interventions should not only target the liver but also the associated cardiometabolic conditions and should be adapted accordingly. The objective of the current review is to critically discuss the particularities in the management of patients with NAFLD-related cirrhosis. We relied on the recommendations of scientific societies and discussed them in the specific context of NAFLD cirrhosis and the surrounding cardiometabolic milieu. Herein, we covered the following aspects: (1) the weight loss strategies through lifestyle interventions to avoid sarcopenia and improve portal hypertension; (2) the optimal control of metabolic comorbidities in particular type 2 diabetes aimed not only to improve cardiovascular morbidity/mortality but also to lower the incidence of cirrhosis-related complications (we discussed various aspects related to the safety of oral antidiabetic drugs in cirrhosis); (3) the challenges in performing bariatric surgery in patients with cirrhosis related to the portal hypertension and the risk of cirrhosis decompensation; (4) the particularities in the diagnosis and management of the portal hypertension and the difficulties in managing patients awaiting for liver transplantation; and (5) the difficulties in developing drugs and conducting clinical trials in patients with NAFLD-related cirrhosis. Moreover, we discussed the emerging options to overcome these obstacles.
尽管非酒精性脂肪性肝病（NAFLD）的发展较为缓慢，但与 NAFLD 相关的肝硬化患者数量却显著增加。尽管肝硬化患者的管理方法在不断发展，但改善与 NAFLD 相关的肝硬化患者的预后仍然是一个挑战，因为这涉及到肝脏、代谢和心血管疾病的交叉点。因此，治疗干预措施不仅应针对肝脏，还应针对相关的代谢性心血管疾病，并应相应地进行调整。本综述的目的是批判性地讨论与 NAFLD 相关的肝硬化患者管理的特殊性。我们参考了科学协会的建议，并在 NAFLD 肝硬化及其周围代谢性心血管环境的具体背景下进行了讨论。在此，我们涵盖了以下几个方面：（1）通过生活方式干预减轻体重的策略，以避免肌肉减少症和改善门脉高压；（2）优化代谢合并症的控制，特别是 2 型糖尿病，不仅旨在改善心血管发病率/死亡率，还旨在降低肝硬化相关并发症的发生率（我们讨论了肝硬化患者口服降糖药物安全性的各个方面）；（3）在与门脉高压和肝硬化失代偿风险相关的肝硬化患者中进行减肥手术的挑战；（4）门静脉高压的诊断和管理的特殊性，以及在等待肝移植的患者中进行管理的困难；（5）在与 NAFLD 相关的肝硬化患者中开发药物和进行临床试验的困难。此外，我们还讨论了克服这些障碍的新选择。
