Nonalcoholic fatty liver disease: new treatments.
Nonalcoholic fatty liver disease: new treatments.
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非酒精性脂肪肝病：新疗法。
DOI：
10.1097/mog.0000000000000175
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发表时间：
2015-05
影响因子：
2.5
通讯作者：
Day CP
中科院分区：
文献类型：
--
作者：
Hardy T;Anstee QM;Day CP
非酒精性脂肪肝是西方世界肝功能障碍的最常见原因，因为它与肥胖、胰岛素抵抗和血脂异常密切相关。非酒精性脂肪性肝炎（NASH）是一个特别的健康问题，因为与疾病进展相关的发病率和死亡率增加。目前，在没有特定的靶向药物治疗的情况下，治疗的主要方法仍然是通过饮食调整和生活方式改变来减轻体重;因此，本文综述的目的是总结NASH当前和新兴治疗的最新证据。一些现有的药物，包括吡格列酮和血管紧张素受体拮抗剂，可能会被重新利用，以帮助治疗这种情况。维生素E可以改善NASH的组织学，但安全性问题限制了其使用。最近，一些专门针对非酒精性脂肪肝发病机制的新药已进入临床试验，包括法尼醇X受体激动剂奥贝胆酸，它已显示出脂肪性肝炎和纤维化的显着组织学改善。饮食/生活方式的改变仍然是治疗的主要手段。对于NASH和晚期纤维化患者，目前使用维生素E和吡格列酮的肝脏药物治疗提供了一些益处;奥贝胆酸似乎很有希望，目前正在进行测试。必须诊断和治疗合并症;心血管疾病仍然是这些患者死亡的主要原因。
Nonalcoholic fatty liver disease is the most common cause of liver dysfunction in the western world because of its close association with obesity, insulin resistance and dyslipidaemia. Nonalcoholic steatohepatitis (NASH) is a particular health concern due to the increased morbidity and mortality associated with progressive disease. At present, without specific targeted pharmacological therapies, the mainstay of therapy remains weight loss through dietary modification and lifestyle change; thus, the purpose of this review is to summarize the recent evidence for current and emerging therapies in NASH. Some existing medications, including pioglitazones and angiotensin receptor antagonists, may be repurposed to help treat this condition. Vitamin E may improve histology in NASH, but safety issues limit its use. Recently, a number of novel agents specifically targeting nonalcoholic fatty liver disease pathogenesis have entered clinical trials, including the farnesoid X receptor agonist obeticholic acid, which has shown significant histological improvements in steatohepatitis and fibrosis. Diet/lifestyle modification remains the mainstay of treatment. For patients with NASH and advanced fibrosis, current liver-directed pharmacotherapy with vitamin E and pioglitazone offer some benefits; obeticholic acid appears promising and is currently being tested. Comorbidities must be diagnosed and treated; cardiovascular disease remains a primary cause of death in these patients.