PERSPECTIVES IN CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
PERSPECTIVES IN CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
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DOI：
10.1016/j.cgh.2016.08.028
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发表时间：
2017-04-01
影响因子：
12.6
通讯作者：
Kim, W. Ray
中科院分区：
文献类型：
--
作者：
Kim, Donghee;Kim, W. Ray
非酒精性脂肪性肝病（NAFLD）是指一组以肝脏脂肪变性为特征的疾病，不存在显著的酒精消耗。NAFLD常见于与肥胖相关的代谢异常患者，如II型糖尿病、血脂异常和代谢综合征。然而，显然，并非所有肥胖受试者都会发生NAFLD，更重要的是，NAFLD可以在非肥胖个体中发现。尽管在所有种族的儿童和成人中均报告了非肥胖受试者发生NAFLD，但即使使用严格的种族特异性体重指数标准来定义肥胖，在亚洲人中也更常见。基于肝活检的研究表明，非肥胖NAFLD和肥胖NAFLD患者的非酒精性脂肪性肝炎和纤维化患病率无显著差异。内脏性肥胖与一般性肥胖相反，高果糖和胆固醇摄入以及遗传风险因素（例如，含腭蛋白样磷脂酶结构域3）可能与非肥胖性NAFLD相关。一般来说，非酒精性脂肪性肝炎与死亡率增加相关，主要是心血管原因，与其他代谢因素无关。虽然关于非肥胖NAFLD死亡率影响的数据还不成熟，但识别高风险非肥胖NAFLD患者并管理其代谢特征可能很重要。目前，生活方式的改变，以减少内脏肥胖，包括饮食的变化和体力活动，仍然是标准的护理与非肥胖NAFLD患者。
Nonalcoholic fatty liver disease (NAFLD) refers to a group of conditions characterized by hepatic steatosis in the absence of significant alcohol consumption. NAFLD is seen commonly in patients with metabolic abnormalities associated with obesity, such as type II diabetes, dyslipidemia, and metabolic syndrome. Evidently, however, not all obese subjects develop NAFLD and, more importantly, NAFLD can be found in nonobese individuals. Although NAFLD occurring in nonobese subjects has been reported in children and adults of all ethnicities, it appears to be recognized more frequently in Asians, even when strict ethnicityspecific body mass index criteria are used to define obesity. Studies based on liver biopsies suggest that the prevalence of nonalcoholic steatohepatitis and fibrosis does not differ significantly between nonobese NAFLD and NAFLD in obese patients. Visceral obesity as opposed to general obesity, high fructose and cholesterol intake, and genetic risk factors (eg, palatin-like phospholipase domain-containing 3) may be associated with nonobese NAFLD. In general, nonalcoholic steatohepatitis is associated with increased mortality, primarily from cardiovascular causes, independent of other metabolic factors. Although data regarding the mortality impact of nonobese NAFLD are not as mature, it may be important to identify high-risk nonobese NAFLD patients and manage their metabolic profile. Currently, lifestyle modification to reduce visceral adiposity, including dietary changes and physical activity, remains the standard of care in patients with nonobese NAFLD.