Management of Nonalcoholic Fatty Liver Disease A 60-Year-Old Man With Probable Nonalcoholic Fatty Liver Disease: Weight Reduction, Liver Biopsy, or Both?
Management of Nonalcoholic Fatty Liver Disease A 60-Year-Old Man With Probable Nonalcoholic Fatty Liver Disease: Weight Reduction, Liver Biopsy, or Both?
复制标题
DOI：
10.1001/jama.2012.8402
复制
发表时间：
2012-08-08
影响因子：
120.7
通讯作者：
Afdhal, Nezam H.
中科院分区：
文献类型：
--
作者：
Afdhal, Nezam H.
非酒精性脂肪性肝病（NAFLD）是美国最常见的肝脏疾病之一，但其最佳治疗方法仍不确定。本文以60岁的肥胖、糖尿病和血清转氨酶水平升高的T先生为例，讨论了基于证据的诊断和治疗方法。NAFLD的诊断是基于患者的临床特征和代谢综合征的危险因素，排除其他肝脏疾病，放射影像和有时活检。此时，最重要的一步是区分单纯性脂肪变性和非酒精性脂肪性肝炎（NASH）。单纯性脂肪变性具有良性的自然病史，但NASH是进行性的，可能导致肝硬化、肝功能衰竭和肝癌。基于证据的治疗方法因缺乏大型随机试验而受到限制，特别是治疗联合试验，但推荐减肥、运动和针对NASH肝损伤机制的药物治疗。改进的非侵入性诊断测试，对NAFLD的自然史有更清晰的认识，以及大规模、精心设计的临床试验是必要的。《美国医学协会杂志》上。2012年;308 (6): 608 - 616
Nonalcoholic fatty liver disease (NAFLD) is one of the most common hepatic disorders in the United States, but uncertainty remains as to the optimal way to manage it. Using the case of Mr T, a 60-year-old man with obesity, diabetes mellitus, and increased serum transaminase levels, an evidence-based approach to diagnosis and treatment is discussed. Diagnosis of NAFLD is based on patient clinical profile and risk factors for metabolic syndrome, the exclusion of other liver diseases, radiologic imaging and sometimes biopsy. At this point in Mr T's disease, the most important step is differentiation between simple steatosis and nonalcoholic steatohepatitis (NASH). Simple steatosis has a benign natural history, but NASH is progressive and may lead to cirrhosis, liver failure, and liver cancer. An evidence-based approach to treatment is limited by lack of large randomized trials, particularly of combinations of therapies, but weight loss, exercise, and medical therapies targeted at the mechanism of liver injury in NASH are recommended. Improved noninvasive diagnostic tests, a clearer understanding of the natural history of NAFLD, and large, well-designed clinical trials are needed. JAMA. 2012;308(6):608-616