非アルコール性脂肪肝疾患:体系的なレビュー
1Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
JAMA
|June 10, 2015
まとめ
非アルコール性脂肪肝疾患 (NAFLD) は数百万人に影響し,非アルコール性脂肪肝炎 (NASH) は心血管疾患と癌のリスクを高めています. 早期の診断と管理は,患者の改善のために不可欠です.
科学分野:
- 肝臓病理学 肝臓病理学
- 内科内科は,内科の内科である.
- 公衆衛生は公衆衛生である.
背景:
- 非アルコール性脂肪肝疾患 (NAFLD) は米国人口の30%に影響し,非アルコール性脂肪肝炎 (NASH) は5%に影響します.
- NASHは,心血管疾患 (死亡の半分につながる) と悪性腫瘍のリスクを大幅に高めます.
- NAFLDの合併症である肝硬変は,肝臓移植の主要な徴候になると予測されています.
研究 の 目的:
- NASHと肝硬変のリスクが高いNAFLD患者を特定する.
- NASH診断のための現在の診断ツールと肝臓生検を評価する.
- NAFLDのスペクトルの管理戦略の概要.
主な方法:
- 2015年2月28日までの記事について,PubMedの文献検索を行いました.
- キーワードにはNAFLD,肝硬変,死亡率,バイオマーカー,治療が含まれていました.
- 選択された88の参照: 16のRCT,44のコホート/ケース・コントロール,6の集団ベース,7のメタ分析.
主要な成果:
- 糖尿病または肥満の50歳以上の患者の66%は,進行した線維症とNASHを患っている可能性があります.
- NASHの診断には依然として肝臓生検が必要ですが,線維症のバイオマーカーが改善しています.
- ビタミンE,ピオグリタゾン,オベチコリック酸などの治療は,控えめな効果を示しているが,FDAの承認は得ていない.
- NASHは心血管疾患と関連しており,NAFLDに関連する肝がんは,時には肝硬変なしで増加しています.
結論:
- 7500万~1億人のアメリカ人がNAFLDを患っており,そのリスクは肝臓を超えて広がっています.
- 医療従事者はNAFLDの広範囲と長期的な影響を認識しなければなりません.
- NASHの早期発見は,進行性肝硬変の移植を含む介入を通じて結果を改善することができます.
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