非酒精性脂肪性肝病治疗的研究进展

摘要

非酒精性脂肪性肝病(NAFLD)的发病率仍在迅速增长并趋于低龄化,日渐成为危害公众健康的主要问题.NAFLD的临床结局并不限于肝硬化、肝癌等肝脏本身的病变,同时与代谢异常所致的动脉粥样硬化性心血管事件密切相关,需要积极治疗干预.改善生活方式是所有NAFLD患者治疗的基石;严重肥胖患者,可考虑减肥手术;伴有糖尿病、高血压、血脂异常等危险因素的患者还需对代谢综合征进行治疗;对于严格生活方式干预无效的NASH患者,可及时加用二甲双胍及胰岛素增敏剂[二甲双胍、过氧化物酶体增殖物激活受体γ(PPAR-γ)激动剂、PPAR-α/δ激动剂、胰高血糖素样1受体激动剂、法尼醇X受体激动剂]、抗氧化剂;已发展至终末期肝病的患者,除预防处理并发症外,可考虑行肝移植.%There is an increasing trend of incidence of non-alcoholic fatty liver disease(NAFLD),which is becoming the main risk of public health.NAFLD leads to liver lesions like cirrhosis and liver cancer,and it is closely related to severe atherosclerotic cardiovascular events caused by metabolic abnormalities.Healthy lifestyle is the cornerstone of treatments of NAFLD;bariatric surgery is a reasonable therapy for severe obesity;patients with diabetes,hypertension,dyslipidemia and other risk factors need strict lifestyle intervention.Nonalcoholic steatohepatitis patients with no improvement after routine treatments could have insulin sensitizers [melbine,peroxisome proliferator-activated receptor γ(PPAR-γ) agonist,PPAR-α/δ agonist,glucagonlike peptide-1 receptor agonist,farnesol X receptor agonist] and antioxidants.End stage liver disease patients should manage symptomatic treatments for complications and consider the feasibility of liver transplantation.