他汀类与非酒精性脂肪肝病患者的卒中预防

摘要

非酒精性脂肪肝病(non-alcoholic fatty liver disease,NAFLD)是慢性肝病中的一个重要类型,其发病率日益增高,是代谢综合征的肝脏表现,与心脑血管病的发生关系密切.对NAFLD患者的卒中预防十分重要.他汀类药物是最重要的一类降胆固醇药物,通过抑制羟甲基戊二酰辅酶A(hydroxy-methyl-glutaryl coenzyme A HMG-CoA)还原酶,减少胆固醇合成,上调肝脏低密度脂蛋白(low-density lipoprotein,LDL)受体,降低循环低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)水平,有效降低卒中风险.此外,他汀类的多效性以及对胆同醇相关细胞信号通路的影响,能减缓或防止NAFLD的进展.由于他汀类药物对肝脏有一定的不良作用,是否能应用于慢性肝病患者存在较大争议.现有证据显示,他汀类药物可在NAFLD患者中安全使用,通常无需监测肝酶,过分关注他汀类药物的肝毒性反而可能采取不恰当的停药,导致心血管事件风险的增高.为此,他汀类对NAFLD患者的有效性及安全性尚需进一步评估.%Non-alcoholic fatty liver disease (NAFLD) is an important type in chronic liver diseases. Its incidence is growing. It is regarded as the liver manifestation of metabolic syndrome, which is closely correlated with the onset of cardiocerehrovascular diseases. The prevention of stroke in patients with NAFLD is very important. Statius are the most important type of medications. They decrease cholesterol synthesis, upregulate low-density lipoprotein (LDL) receptor in the liver and lower the levels of low-density lipoprotein cholesterol (LDL-C) in circulation through inhibiting hydroxy-methyl-glutaryl coenzyme A (HMG-CoA) reductase, and thus effectively reduce the risks of stroke. Besides, the pleiotropy of statins and their effects on cholesterol-related cell signaling pathway may relieve or prevent the progression of NAFLD. There is greater controversy about whether statins can be used in patients with chronic liver diseases because they have some adverse reactions on liver, The evidence available has demonstrated that statins can he used safely in patients with NAFLD, and usually liver enzymes have no need to be monitored. Too much attention on the liver toxicity of statins may result in inappropriate drug withdrawal, and brings about the increased risk of cardiovascular events. So further evaluation is needed for the efficacy and safety of statins in patients with NAFLD.