Therapies in non-alcoholic steatohepatitis (NASH).
Therapies in non-alcoholic steatohepatitis (NASH).
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DOI：
10.1111/liv.13302
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发表时间：
2017-01
期刊：
影响因子：
--
通讯作者：
Sanyal AJ
中科院分区：
文献类型：
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作者：
Oseini AM;Sanyal AJ
非酒精性脂肪性肝病 (NAFLD) 的标志是肝细胞中脂肪过多积聚，这可能是孤立事件（非酒精性脂肪肝，NAFL），也可能伴有伴或不伴纤维化的炎症和细胞损伤证据（非酒精性脂肪性肝炎，NASH）。 NASH 是 NAFLD 的一种更具侵袭性的形式，可能会进展为肝硬化和肝细胞癌。据估计，NASH 将在未来十年内取代丙型肝炎病毒感染，成为美国肝移植的主要原因，而目前 FDA 还没有批准针对这种疾病的治疗方法，因此现在比以往任何时候都更加迫切需要找到合适的治疗靶点。饮食和其他生活方式的改变一直难以维持，仅靠这种方法并没有减缓疾病的上升趋势。虽然维生素 E 和吡格列酮等传统疗法对脂肪变性和炎症具有显着效果，但它们对纤维化没有影响，而纤维化是这种情况下死亡率的最强指标。然而，对 NASH 发病机制和进展的理解已经发生变化，并且正在评估几种有前景的针对纤维化并可能逆转纤维化的新疗法，这使得 NASH 治疗的未来前景更加乐观。
The hallmark of non-alcoholic fatty liver disease (NAFLD) is excessive fatty accumulation in the hepatocytes, which may be an isolated event (non-alcoholic fatty liver, NAFL) or accompanied by evidence of inflammation and cell injury with or without fibrosis (non-alcoholic steatohepatitis, NASH). NASH, the more aggressive form of NAFLD, may progress to cirrhosis and hepatocellular carcinoma. Because it has been estimated that NASH will overtake hepatitis C virus infection as the leading cause of liver transplantation in the US in the coming decade, and there are no current FDA-approved therapies for this disease, the need to find appropriate therapeutic targets is now more urgent than ever before. Diet and other life-style modifications have always been difficult to maintain and this approach alone has not slowed the rising tide of the disease. While the results of traditional therapies such as vitamin E and pioglitazone have been significant for steatosis and inflammation, they have had no effect on fibrosis, which is the strongest indicator of mortality in this condition. However, the understanding of the pathogenesis and progression of NASH has evolved and several promising novel therapies to target and possibly reverse fibrosis are being evaluated, making the future outlook of NASH therapy more optimistic.