Department of Pediatrics, Boston Children Hospital, Harvard Medical School, Boston, MA, USA.
University of Alabama at Birmingham, 1601, 4th Avenue South, CPP M 30, Birmingham, AL 35233, USA.
Endocrinol Metab Clin North Am. 2023 Sep;52(3):445-457. doi: 10.1016/j.ecl.2023.01.003. Epub 2023 Feb 26.
Dyslipidemia has been linked metabolic-associated fatty liver disease (MAFLD). Several genes and transcription factors involved in lipid metabolism can increase susceptibility to MAFLD. Multiple parallel 'hits' have been proposed for developing hepatic steatosis, NASH, and MAFLD, including insulin resistance and subsequent free fatty acid excess, de novo lipogenesis, and excessive hepatic triglyceride and cholesterol deposition in the liver. This lead to defective beta-oxidation in the mitochondria and VLDL export and increased inflammation. Given the significant cardiovascular risk, dyslipidemia associated with MAFLD should be managed by lifestyle changes and lipid-lowering agents such as statins, fenofibrate, and omega-3 fatty acids, with judicious use of insulin-sensitizing agents, and adequate control of dysglycemia.
血脂异常与代谢相关脂肪性肝病(MAFLD)有关。参与脂质代谢的几个基因和转录因子可增加 MAFLD 的易感性。已经提出了多种平行的“打击”来发展肝脂肪变性、NASH 和 MAFLD,包括胰岛素抵抗和随后的游离脂肪酸过多、从头脂肪生成以及肝脏中过多的肝甘油三酯和胆固醇沉积。这导致线粒体中的β氧化和 VLDL 输出缺陷以及炎症增加。鉴于心血管风险显著增加,MAFLD 相关的血脂异常应通过生活方式改变和降脂药物(如他汀类药物、非诺贝特和欧米伽 3 脂肪酸)来管理,谨慎使用胰岛素增敏剂,并充分控制血糖异常。