Nonalcoholic Fatty Liver Disease
Nonalcoholic Fatty Liver Disease
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DOI：
10.1007/978-1-4471-4715-2_9
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发表时间：
2021-10
期刊：
影响因子：
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通讯作者：
N. Bergasa
中科院分区：
文献类型：
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作者：
N. Bergasa
非酒精性脂肪性肝病（NAFLD）包括脂肪变性和脂肪性肝炎，可进展为纤维化和肝硬化及其并发症。它与代谢综合征的特征有关;然而，有瘦脂肪肝。肝脏脂肪堆积的原因尚不清楚。NAFLD是一种排除性诊断。血清肝脏特征是肝细胞，但可以混合。瞬时弹性成像提示脂肪变性和纤维化。组织学上，以肝细胞气球样变性为特征的脂肪变性和脂肪性肝炎是典型的。肝纤维化可预测肝脏疾病的进展和并发症。NAFLD的遗传易感性包括含有马铃薯糖蛋白样磷脂酶结构域的基因rs738409-G和葡萄糖激酶调节因子rs780094-T。对于瘦型NAFLD，已经发现CETP、TMSF 2、干扰素λ和PENT.CD44蛋白和巨噬细胞活化触发并维持NAFLD诱导的肝损伤。脂肪酸（FA）的氧化和氧化应激，FA和细胞膜磷脂组成的变化，以及细胞胆固醇浓度的改变有助于脂肪肝疾病的进展。在瘦型NAFLD中，促成因素包括游离脂肪酸（FFA）的高循环、低脂联素浓度和线粒体功能降低。在NAFLD的各个阶段正在研究的药物包括核受体激活剂，包括奥贝胆酸和elafibranor，维生素E，抗氧化剂，利拉鲁肽，GLP 1激动剂，吡格列酮，脂肪性肝炎中的PPAR γ激动剂，selonsertib，Ask-1抑制剂和ceniciviroc，CCR 2/CCR 2。在符合手术标准的肥胖和NAFLD患者中可以考虑减肥手术。
Nonalcoholic fatty liver disease (NAFLD) comprises steatosis and steatohepatitis that can progress to fibrosis and cirrhosis and its complications. It is associated with features of the metabolic syndrome; however, there is lean fatty liver. The cause of fat accumulation in the liver is unknown.NAFLD is a diagnosis of exclusion. The serum liver profile is hepatocellular, but it can be mixed. Transient elastography informs on steatosis and fibrosis. Histologically, steatosis and steatohepatitis characterized by ballooning degeneration of hepatocytes are typical. Fibrosis predicts progression and complications from liver disease.A genetic predisposition for NAFLD that includes the genes patatin-like phospholipase domain-containing 3, rs738409-G, and glucokinase regulator, rs780094-T, has been identified. For lean NAFLD,CETP, TMSF2,interferon lambda, andPENThave been found.The CD44 proteins and macrophage activation trigger and perpetuate NAFLD induced liver injury. Oxidation of fatty acids (FA) and oxidative stress, changes in the FA and cellular membranes phospholipid composition, and altered cellular cholesterol concentration contribute to fatty liver disease progression. In lean NAFLD, contributing factors include high circulation of free fatty acids (FFA), low adiponectin concentration, and decreased mitochondrial function.The treatment of NAFLD concerns the treatment of comorbidities. Medications being studied in various stages of NAFLD include the nuclear receptor activators including obeticholic acid, and elafibranor, vitamin E, an antioxidant, liraglutide, a GLP 1 agonist, pioglitazone, a PPAR gamma agonist in steatohepatitis, selonsertib, an Ask-1 inhibitor, and ceniciviroc, a CCR2/CCR2.Bariatric surgery can be considered in patients with obesity and NAFLD who meet the criteria for the procedure.