JAMA:非酒精性脂肪肝的诊断和管理(指南纲要)

创作:徐笑 审核:可乐 12月06日
影像学检测出脂肪肝的患者,若没有相关症状且生化指标正常,需评估代谢风险因素和饮酒、用药情况;
不建议高危人群进行非酒精性脂肪肝(NAFLD)常规筛查,FIB-4和NAFLD纤维化分数等指标,以及无创的振动控制瞬态弹性成像和磁共振弹性成像,可评估肝纤维化;
低热量饮食和运动减肥可改善NAFLD,药物治疗应限于活检确诊的非酒精性脂肪性肝炎(NASH)和晚期纤维化患者;
他汀类药物可治疗NAFLD、NASH和代偿性NASH肝硬化患者的血脂异常。
延伸阅读
JAMA [IF:44.405]

Diagnosis and Management of Nonalcoholic Liver Disease

非酒精性肝病的诊断与治疗 (指南标题——非酒精性脂肪肝的诊断和管理:美国肝病研究协会的实践指南)

11-26, Guideline, 10.1001/jama.2018.17365more

Abstract:
Nonalcoholic fatty liver disease affects about 25% of the adult population globally and is strongly associated with metabolic syndrome, affecting most patients who have dyslipidemia, obesity, or type 2 diabetes .1 About 2% to 7% of those with NAFLD have evidence of NASH on liver biopsy with hepatic inflammation and injury.2 Long-standing NAFLD and NASH can result in cirrhosis and its complications, including hepatocellular carcinoma. Currently, NASH ranks as the second most common reason for liver transplant in the United States and will likely surpass hepatitis C in the coming years as the most common. A diagnosis of NAFLD requires evidence of hepatic steatosis (on imaging or histology) in the absence of secondary causes of steatosis or other liver disease, such as excessive alcohol intake, hepatitis C, Wilson disease, and hepatotoxic medications. Methods to noninvasively assess for advanced fibrosis (bridging fibrosis or cirrhosis) are evolving and can help target which patients should receive a liver biopsy and, potentially, pharmacologic therapy.

First Authors:
Sonali Paul

Correspondence Authors:
Andrew M Davis

All Authors:
Sonali Paul,Andrew M Davis