Increased risk of cardiovascular disease in non-alcoholic fatty liver disease: causal effect or epiphenomenon?
Increased risk of cardiovascular disease in non-alcoholic fatty liver disease: causal effect or epiphenomenon?
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DOI：
10.1007/s00125-008-1135-4
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发表时间：
2008-11-01
期刊：
影响因子：
8.2
通讯作者：
Marchesini, G.
中科院分区：
文献类型：
--
作者：
Targher, G.;Marra, F.;Marchesini, G.
非酒精性脂肪性肝病（NAFLD）包括从单纯脂肪变性到脂肪性肝炎和肝硬化的一系列病症，已达到流行病的比例，并且是社区中慢性肝病的最常见原因。据估计，一般人群中NAFLD的患病率在20%至30%之间，但在2型糖尿病患者中，该值要高得多（类似于70-80%），这些患者也有更高的发生晚期纤维化和肝硬化的风险。NAFLD的重要性及其与代谢综合征的密切关系日益受到重视，这激发了人们对NAFLD在心血管疾病（CVD）发展中可能发挥的作用的兴趣。一些流行病学研究表明，NAFLD，特别是其更严重的形式，与CVD风险增加有关，独立于潜在的心脏代谢风险因素。这表明NAFLD不仅是CVD的标志物，而且还可能积极参与其发病机制。联系NAFLD和CVD的可能的分子介质包括从肝脏释放促动脉粥样硬化因子（C-反应蛋白、纤维蛋白原、纤溶酶原激活物抑制剂-1和其他炎性细胞因子）以及NAFLD本身对全身胰岛素抵抗和致动脉粥样硬化性血脂异常的贡献，进而促进CVD进展。NAFLD对CVD风险的临床影响值得特别关注，因为在越来越多的NAFLD患者中筛查和监测策略的意义。
Non-alcoholic fatty liver disease (NAFLD), comprising a spectrum of conditions ranging from pure steatosis to steatohepatitis and cirrhosis, has reached epidemic proportions and represents the most common cause of chronic liver disease in the community. The prevalence of NAFLD has been estimated to be between 20% and 30% in the general population, but this value is much higher (similar to 70-80%) in type 2 diabetic patients, who are also at higher risk of developing advanced fibrosis and cirrhosis. Increasing recognition of the importance of NAFLD and its strong relationship with the metabolic syndrome has stimulated an interest in the possible role of NAFLD in the development of cardiovascular disease (CVD). Several epidemiological studies indicate that NAFLD, especially in its more severe forms, is linked to an increased risk of CVD, independently of underlying cardiometabolic risk factors. This suggests that NAFLD is not merely a marker of CVD, but may also be actively involved in its pathogenesis. The possible molecular mediators linking NAFLD and CVD include the release of pro-atherogenic factors from the liver (C-reactive protein, fibrinogen, plasminogen activator inhibitor-1 and other inflammatory cytokines) as well as the contribution of NAFLD per se to whole-body insulin resistance and atherogenic dyslipidemia, in turn favouring CVD progression. The clinical impact of NAFLD on CVD risk deserves particular attention in view of the implications for screening and surveillance strategies in the growing number of patients with NAFLD.