非酒精性脂肪肝疾病:一个系统审查
1Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
JAMA
|June 10, 2015
概括
非酒精性脂肪性肝病 (NAFLD) 影响着数百万人,非酒精性脂肪性肝炎 (NASH) 增加了心血管疾病和癌症的风险. 早期识别和管理对于更好的患者结果至关重要.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 内部医学 内部医学
- 公共卫生 公共卫生
背景情况:
- 非酒精性脂肪性肝病 (NAFLD) 影响美国30%的人口,非酒精性脂肪性肝炎 (NASH) 影响5%的人口.
- 纳什显著增加了心血管疾病 (导致一半的死亡) 和恶性瘤的风险.
- 预计NAFLD的并发症肝硬化将成为肝移植的首要征兆.
研究的目的:
- 识别NAFLD患者有NASH和肝硬化高风险.
- 评估目前的诊断工具和肝活检,以诊断NASH.
- 概述NAFLD频谱的管理策略.
主要方法:
- 在PubMed的文献中搜索到2015年2月28日的文章.
- 关键词包括NAFLD,肝硬化,死亡率,生物标志物和治疗.
- 选择了88个参考:16个RCT,44个队列/病例控制,6个基于人口的,7个元分析.
主要成果:
- 在50岁以上的糖尿病或肥胖患者中,66%的患者可能患有NASH与晚期纤维化.
- 对于NASH诊断,肝脏活检仍然是必要的,但纤维化生物标志物正在改善.
- 改变生活方式是关键;像维生素E,皮奥格利塔和肥酸这样的治疗方法显示出适度的益处,但缺乏FDA的批准.
- NASH与心血管疾病有关,NAFLD相关的肝癌正在上升,有时没有肝硬化.
结论:
- 75-100万美国人患有NAFLD,风险超出了肝脏.
- 医疗保健提供者必须认识到NAFLD的广泛范围和长期后果.
- 早期发现NASH可以通过干预改善结果,包括为晚期肝硬化进行移植.
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