Hepatic steatosis in obese patients: clinical aspects and prognostic significance.
Hepatic steatosis in obese patients: clinical aspects and prognostic significance.
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DOI：
10.1111/j.1467-789x.2004.00126.x
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发表时间：
2004-02-01
期刊：
影响因子：
--
通讯作者：
Marchesini, G
中科院分区：
文献类型：
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作者：
Festi, D;Colecchia, A;Marchesini, G
非酒精性脂肪性肝病是一种新的临床病理条件的新兴的重要性，现在被认为是最常见的原因异常肝脏检查。其特征在于广泛的肝损害：单纯性脂肪变性可进展为晚期纤维化，并通过脂肪性肝炎发展为隐源性肝硬化，最终发展为肝细胞癌。肥胖是儿童和成人脂肪肝发展的最重要的单一风险因素;肥胖也预示着纤维化的存在，可能进展为晚期肝病。从致病的角度来看，胰岛素抵抗在肝细胞内甘油三酯的积累和炎症级联反应的启动中起着重要作用。慢性肝细胞损伤、坏死性炎症、星状细胞活化、进行性纤维化和最终肝硬化可由肝脂质过氧化和损伤相关细胞因子释放引发。在过去的几年里，一些初步研究表明，胰岛素增敏剂，抗氧化剂或细胞保护药物的治疗可能是有用的，但没有证据支持的随机临床试验。改变生活方式（例如饮食和运动）以减少肥胖仍然是预防和治疗疾病的主要手段，这使得大量个体在不久的将来面临晚期肝病的风险。
Non-alcoholic fatty liver disease is a new clinicopathological condition of emerging importance, now recognized as the most common cause of abnormal liver tests. It is characterized by a wide spectrum of liver damage: simple steatosis may progress to advanced fibrosis and to cryptogenic cirrhosis through steatohepatitis, and ultimately to hepatocellular carcinoma. Obesity is the most significant single risk factor for the development of fatty liver, both in children and in adults; obesity is also predictive of the presence of fibrosis, potentially progressing to advanced liver disease. From a pathogenic point of view, insulin resistance plays a central role in the accumulation of triglycerides within the hepatocytes and in the initiation of the inflammatory cascade. Chronic hepatocellular injury, necroinflammation, stellate cell activation, progressive fibrosis and ultimately, cirrhosis may be initiated by peroxidation of hepatic lipids and injury-related cytokine release. In the last few years, several pilot studies have shown that treatment with insulin-sensitizing agents, anti-oxidants or cytoprotective drugs may be useful, but there is no evidence-based support from randomized clinical trials. Modifications in lifestyle (e.g. diet and exercise) to reduce obesity remain the mainstay of prevention and treatment of a disease, which puts a large number of individuals at risk of advanced liver disease in the near future.