60% 90% NASH 20% 25% 2% NAFLD. ( body mass index, BM I) ( ) NAFLD

Transkript

1 120 ( ) R57515 A (2010) (NAFLD ) ( IR ), (ALD ),, (NAFL) (NASH ) [ 1, 2 ] NAFLD 21 [ 3 ] NAFLD, [ 4 9 ],, 2006 [ 10 ] 3 5 [ 11 ],, : ,, NAFLD,, NAFLD,, NAFLD, DO I: /cma. j. jssn :, , E - mail: fanjiangao@gam il. com 1 NAFLD, NAFLD 20% 33%, NASH 10% 20% 2% 3% [ 1, 2, 12 ] SFL 60% 90% NASH 20% 25% 2% 8%, 2 NAFLD 28% 55% 27% 92% [ 1, 2, 12, 13 ], 20 NAFLD, NAFLD 15% [ 3 ] NAFLD :, IR ( 2 ) [ 3, 12, 13 ] ( HCV ), [ 3, 12, 14 ], ( body mass index, BM I) ( ) NAFLD [ 3, 12, 13 ] NAFLD, BM I [ 3, 12, 13 ] 3 HCV ( hepatitis B virus, HBV ) IR ; NAFLD HBV DNA HBV [ 3, 4, 16 ] 2 NAFLD ( ) NAFL, ( 10 20) ( 016% 3% ), NASH (10 15) 15% 25% [ 1, 2 ] > 50 ( ) 2 (ALT) (AST) ALT > 1 NASH

2 [ 1, 2, 9, 17 ] NAFLD, NASH NAFL [ 1, 2 ], NASH [ 1, 2, 13, 17 ] IR, NAFL NASH ; /, NAFL [ 13, 16 ],, NAFL, 3 [ 1, 2, 9, 13, 14 ], NAFLD [ ALT - ( GGT) ], [ 1, 2, 9 ] NAFL NASH, [ 1, 2, 9 ] NAFLD ( NAFL), NAFLD BM I [ 3, 13, 18, 19 ] NAFLD, (6 15) 2 [ 2, 3, 9, 13, 18, 19 ] NAFLD 3 [ 3, 5, 9, 10 ] : (1) 140 g/ ( < 70 g/ ) ; (2) / CT 110, / CT ; ( 3), NAFLD : (1) [ 4 ] ; ( ) ( 2) ALT ( ) AST GGT [ 4, 5, 9 ] IR, NAFLD [ 4, 5, 9 ] NAFLD 3, [ 4, 5, 9, 20 ], NASH ( ) [ 21 ] NAFLD NASH, NAFLD (NAFLD activity score, NAS) [ 4, 20 ] NAS ( 0 8 ) : ( 1 ) : 0 ( < 5% ) ; 1 ( 5% 33% ) ; 2 ( 34% 66% ) ; 3 ( > 66% ) ; ( 2 ) ( 20 ) : 0, ; 1 ( < 2 ) ; 2 (2 4 ) ; 3 ( > 4 ) ; (3) : 0, ; 1, ; 2, NAS, NAS < 3 NASH, NAS > 4 NASH, NASH [ 20 ] > 33% NAFL, [ 10 ] (0 4) : 0: ; 1a: 3 ; 1b: 3 ; 1c: ; 2: 3 ; 3: ; 4:, NASH ( ) NAFLD, [ 4, 20 ] [ 4 ] : ( 1) ( ), ; ( 2) ; ( 3) CT, , , 015 [ 10 ] , 5 3 [ 4, 22 ] : (1) : > 90 cm ( ), > 80 cm ( ), ( ) BM I > 25 kg/m 2 ; (2) ( triglyc2 erides, TG) : TG 117 mmol/l, TG ; (3) ( high - den2 sity lipop rotein cholesterol, HDL - C) : HDL - C < 1103 mmol/l ( ), < 1129 mmol/l ( ) ; (4) : 130 /85 mm Hg (1 mm Hg = kpa) ; ( 5) ( fasting p lasma glucose, FPG) : FPG 516 mmol/l NAFLD

3 122, (ALD ) ; ( ) IR ( Mauriac ) [ 4, 10, 16 ] ( ) GGT NAFLD, ALD - 1 ;, [ 4 10 ] HBV 3 HCV, NAFLD [ ] HB sag, HBV DNA 10 4 /m l, NAFLD [ 4, 15, 16 ] ( < 140 g/, < 70 g/ ) ( > 280 g/, > 140 g/ ), [ 4, 16 ], ( ), ALD NAFLD [ 16 ] ( 2, ), [ 4 10, 13, 23, 24 ] ( ), NAFLD [ 4 10, 17, 23, 24 ], : (1) ( ) ; ( 2) ; (3), ALT AST GGT ; ( 4) HB sag ( HBV DNA ) - HCV ( HCV RNA ) ; ( 5) TG HDL - C - ; (6) FPG, FPG 516 mmol/l 75 g (o2 ral glucose tolerance test, OGTT) NAFLD, [ 4 10, 17, 23, 24 ] : ( 1) FPG IR ( homeostatic model as2 sessment, HOMA - IR), OGTT ; (2) C - ; (3) - ; (4) ; (5),, CT ; (6) ; (7) NAFL NASH NAFLD, NAFLD : (1) ; ( 2) ; (3) ; (4) ( ) ; ( 5) [ 4, 9, 17, 23, 24 ], IR IR ; TG ; X CT ; CT ; NAFL NASH, [ 4 10, 17, 23, 24 ] 4 NAFLD NAFL, NAFLD IR,, ; NASH,

4 NASH, [ 4 10, 17, ] 4 411,, ( ),, KJ ( ) ;,, ;, 4, 150 m in [ 4 10, 17, 23, ] NAFLD [ 4, 9 ] ( - 1, - 2) [ 10 ] ( ) 412, NAFLD ( 6 12 ) 5%, [ 4 10, 17, 23, 27 ] ( - 1, - 2) -, [ 4 10, 17, 23, 24, 27 ] ( - 1) NAFLD ( - 1), [ 4, 9, 10 ] 413 IR,, ( ) ( 3 ), NAFLD ( ) [ 4 10, 17, 23 24, 29 ] ( ) NAFLD [ 4 10, 17, 23, 24 ], ( - 1, - 2, - 3), 414 ( ) NAFLD NASH, -,,,, [ 10 ] 415 NAFLD [ 4 10, 17, 23, 24 ], NAFLD / NASH [ 10, 16, 24 ], ( ) : ( 1) NASH ; (2) ( ), 2 NAFLD ; (3) ; ( 4), ( ) E S ( - 1, - 2, - 3), , ( III) NASH NAFLD [ 9 10, 17, 23, 24 ] ( - 2), NAFLD [ 9, 10, 17, 23, 24 ] ,, [ 9, 10 ] ( ) 512, ; [ 4, 9, 10, 17, 23, 24 ] ( ) 513 NAFLD, [ 6, 9 ] ( ) [ 9, 10, 13, 25, 29 ] ( - ) ( ) ( ) : ( ) ; ( ) ; ( ) ; ( ) : ( ) ; ( ) ; (

5 124 ) ; ( ) ; ( ) ; ( ) ; ( ) ; ( ) ; ( ) ; ( ) ; ( ) ; ( ) ; ( ) ; ( ) ; ( ) [ ] [ 1 ] Farrell GC, Larter CZ. Nonalcoholic fatty liver disease: from steato2 sis to cirrhosis[ J ]. Hepatology, 2006, 43 (2 Supp l 1) S99 - S112. [ 2 ] de A lwis NM, Day CP. Non - alcoholic fatty liver disease: the m ist gradually clears[ J ]. J Hepatol, 2008, 48 ( Supp l 1) S104 - S112. [ 3 ] Fan JG, Farrell GC. Ep idem iology of non - alcoholic fatty liver dis2 ease in China[ J ]. J Hepatol, 2009, 50 (1) [ 4 ] Farrell GC, Chitturi S, Lau GK, et al. Guidelines for the assessment and management of non - alcoholic fatty liver disease in the A sia - Pacific region: executive summary [ J ]. J Gastroenterol Hepatol, 2007, 22 (6) [ 5 ]American Gastroenterological A ssociation. American Gastroenterolog2 ical A ssociation medical position statement: disease[ J ]. nonalcoholic fatty liver Gastroenterology, 2002, 123 (5) [ 6 ] Grattagliano I, Portincasa P, Palm ieri VO, et al. Managing nonalco2 holic fatty liver disease: recommendations for fam ily physicians[ J ]. Can Fam Physician, 2007, 53 (5) [ 7 ] Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome [ J ]. Lancet, 2005, 365 (9468) [ 8 ]Cohen DE, Anania FA, Chalasani N, et al. An assessment of statin safety by hepatologists[ J ]. Am J Cardiol, 2006, 97 ( 8A ) 77C - 81C. [ 9 ] Vuppalanchi R, Chalasani N. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: Selected practical issues in their evalua2 tion and management[ J ]. Hepatology, 2009, 49 (1) [ 10 ] ZengMD, Fan JG, Lu LG, et al. Guidelines for the diagnosis and treatment of nonalcoholic fatty liver diseases[ J ]. J D ig D is, 2008, 9 (2) [ 11 ]Lok AS, McMahon BJ; Practice Guidelines Comm ittee, American A ssociation for the Study ofl iverd iseases (AASLD). Chronic hepa2 titis B: update of recommendations[ J ]. Hepatology, 2004, 39 (3) [ 12 ]Angulo P. GI ep idem iology: nonalcoholic fatty liver disease [ J ]. A liment Pharmacol Ther, 2007, 25 (8) [ 13 ] Fan JG, Saibara T, Chitturi S, et al. W hat are the risk factors and settings of non - alcoholic fatty liver disease in A sia - Pacific? [ J ]. J Gastroenterol Hepatol, 2007, 22 (6) [ 14 ]Cheung O, Sanyal AJ. Hepatitis C infection and nonalcoholic fatty liver disease[ J ]. Clin L iver D is, 2008, 12 (3) [ 15 ] Fan JG, Chitturi S. HepatitisB and fatty liver: causal or coinciden2 tal? [ J ]. J Gastroenterol Hepatol, 2008, 23 (5) [ 16 ]. [ J ]., 2009, 17 (11) [ 17 ] Torres DM, Harrison SA. D iagnosis and therapy of nonalcoholic steatohepatitis[ J ]. Gastroenterology, 2008, 134 (6) [ 18 ] Fan JG. Impact of non - alcoholic fatty liver disease on accelerated metabolic comp lications[ J ]. J D ig D is, 2008, 9 (2) [ 19 ]Bugianesi E. Nonalcoholic fatty liver disease (NAFLD) and cardiac lipotoxicity: Another piece of the puzzle[ J ]. Hepatology, 2008, 47 (1) 2-4. [ 20 ] Kleiner DE, B runt EM, Van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease[ J ]. Hepatology, 2005, 41 (6) [ 21 ]Loomba R, Sirlin CB, Schwimmer JB, et al. Advances in pediatric nonalcoholic fatty liver disease[ J ]. Hepatology, 2009, 50 (4) [ 22 ] Fan JG, Peng YD. Metabolic syndrome and non - alcoholic fatty liver disease: A sian definitions and A sian studies[ J ]. Pancreat D is Int, 2007, 6 (6) Hepatobiliary [ 23 ]A li R, Cusi K. New diagnostic and treatment app roaches in non - alcoholic fatty liver disease (NAFLD) [ J ]. Ann Med, 2009, 41 ( 4) [ 24 ]. [ J ]., 2009, [ 25 ] Fan JG, Farrell GC. A sia - Pacific working party for p revention of hepatocellular carcinoma. Prevention of hepatocellular carcinoma in non - viral related liver diseases[ J ]. J Gastroenterol Hepatol, 2009, 24 (5) [ 26 ]Bellentani S, Dalle Grave R, Suppini A, et al. Behavior therapy for nonalcoholic fatty liver disease: the need for a multidisciplinary app roach[ J ]. Hepatology, 2008, 47 (2) [ 27 ]Hainer V, Top lak H, M itrakou A. Treatment modalities of obesity: what fits whom? [ J ]. D iabetes Care, 2008, 31 ( Supp l 2) S269 - S277 [ 28 ] Zivkovic AM, German JB, Sanyal AJ. Comparative review of diets for the metabolic syndrome: implications for nonalcoholic fatty liver disease[ J ]. Am J Clin Nutr, 2007, 86 (2) [ 29 ]R iley P, A lbakirm, O Donohue J, et al. Prescribing statins to pa2 tients with nonalcoholic fatty liver disease: real cardiovascular bene2 fits outweigh theoretical hepatotoxic risk [ J ]. Cardiovasc Ther, 2009, 27 (3)