Diagnosis and Management of Nonalcoholic Fatty Liver Disease and Its Hemostatic/Thrombotic and Vascular Complications
Diagnosis and Management of Nonalcoholic Fatty Liver Disease and Its Hemostatic/Thrombotic and Vascular Complications
复制标题
DOI：
10.1055/s-0033-1334866
复制
发表时间：
2013-03-01
影响因子：
5.7
通讯作者：
Byrne, Christopher D.
中科院分区：
文献类型：
--
作者：
Targher, Giovanni;Byrne, Christopher D.
非酒精性脂肪性肝病（NAFLD）代表一系列进行性肝病，包括单纯性脂肪变性、非酒精性脂肪性肝炎（NASH）、纤维化和最终肝硬化。NAFLD与代谢综合征的特征密切相关，包括腹部超重/肥胖、高血压、致动脉粥样硬化性血脂异常、葡萄糖耐受不良或2型糖尿病。随着越来越多的久坐不动的生活方式和不断变化的饮食模式的出现，肥胖和胰岛素抵抗的患病率增加，因此，NAFLD已迅速成为许多发达国家慢性肝病的最常见原因。重要的是，越来越多的证据表明NAFLD与血栓形成倾向密切相关，这可能至少部分导致这些患者中观察到的动脉粥样硬化血栓形成事件风险增加。NAFLD，特别是其坏死性炎症形式（NASH），释放多种促炎和促血栓形成介质，其在急性动脉粥样硬化血栓形成并发症的发展和进展中起重要作用。NAFLD还加重全身和肝脏胰岛素抵抗并引起致动脉粥样硬化性血脂异常。本综述的目的是简要讨论NAFLD的流行病学和诊断，总结支持NAFLD与各种凝血和纤溶障碍之间强相关性的证据及其对动脉粥样硬化血栓形成并发症发展的影响，并讨论一些可能影响NAFLD及其相关血管并发症的治疗方案。
Nonalcoholic fatty liver disease (NAFLD) represents a spectrum of progressive liver disease encompassing simple steatosis, nonalcoholic steatohepatitis (NASH), fibrosis, and, ultimately, cirrhosis. NAFLD is strongly associated with features of the metabolic syndrome including abdominal overweight/obesity, hypertension, atherogenic dyslipidemia, glucose intolerance, or type 2 diabetes. With the advent of increasingly sedentary lifestyles and changing dietary patterns, the prevalence of obesity and insulin resistance has increased and, with this, NAFLD has rapidly become the most common cause of chronic liver disease in many developed countries. Importantly, accumulating evidence indicates that NAFLD is strongly associated with a prothrombotic tendency, which may, at least in part, contribute to the increased risk of atherothrombotic events observed in these patients. NAFLD, especially in its necroinflammatory form (NASH), releases a variety of proinflammatory and prothrombotic mediators that play important roles in the development and progression of acute atherothrombotic complications. NAFLD also exacerbates systemic and hepatic insulin resistance and causes atherogenic dyslipidemia. The purpose of this review is to briefly discuss the epidemiology and diagnosis of NAFLD, to summarize the rapidly expanding body of evidence that supports a strong association between NAFLD and various disorders of coagulation and fibrinolysis and their implications for the development of atherothrombotic complications, and to discuss some of the treatment options that may influence both NAFLD and its related vascular complications.