AGA临床实践指南更新:瘦型NAFLD的诊断和管理(专家评议)
AGA clinical practice update:diagnosis and management of nonalcoholic fatty liver disease in lean individuals:expert review
苏殷实 1陈源文1
作者信息
- 1. 复旦大学附属华东医院消化内科,上海 200040
- 折叠
摘要
非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)被公认为是引发慢性肝病的一大主要病因,其影响了超过25％的美国以及全世界人口.每4例NAFLD患者中就有1例患有非酒精性脂肪性肝炎,其可以导致肝硬化、肝功能失代偿和肝细胞癌等并发症的发生,从而与患病和死亡显著相关.尽管NAFLD主要存在于肥胖和(或)2型糖尿病患者中,但据估计有7％-20％的NAFLD患者为瘦人体质.在临床评估患有遗传性疾病、脂肪代谢障碍、药物源性脂肪肝和炎症性疾病等的瘦型NAFLD患者时,临床医师所能参考的指导性意见十分有限.越来越多的研究数据为瘦型NAFLD患者的流行病学、疾病自然史、预后和死亡的特征提供了更为有力的证据.多项研究发现,瘦型NAFLD患者的心血管疾病与肝脏疾病死亡率以及全因死亡率相较于无NAFLD的瘦人群体均有升高.本文作为美国胃肠病学会临床实践更新,将提供"最佳实践建议"以通过循证医学途径来帮助临床医师对瘦型NAFLD进行诊断、分期和处理.
Abstract
Nonalcoholic fatty liver disease(NAFLD)is well recognized as a leading etiology for chronic liver dis-ease,affecting＞25％of the US and global populations.Up to 1 in 4 individuals with NAFLD have nonalcoholic steato-hepatitis,which is associated with significant morbidity and mortality due to complications of liver cirrhosis,hepatic de-compensation,and hepatocellular carcinoma.Although NAFLD is observed predominantly in persons with obesity and/or type 2 diabetes mellitus,an estimated 7％-20％of individuals with NAFLD have lean body habitus.Limited guidance is available to clinicians on appropriate clinical evaluation in lean individuals with NAFLD,such as for inherited/genetic disorders,lipodystrophy,drug-induced NAFLD,and inflammatory disorders.Emerging data now provide more robust evidence to define the epidemiology,natural history,prognosis,and mortality of lean individuals with NAFLD.Multiple studies have found that NAFLD among lean individuals is associated with increased cardiovascular,liver,and all-cause mortality relative to those without NAFLD.This American Gastroenterological Association Clinical Practice Update pro-vides Best Practice Advice to assist clinicians in evidence-based approaches to the diagnosis,staging,and management of NAFLD in lean individuals.
关键词
非酒精性脂肪性肝病/指南/诊断/治疗/适应证Key words
Nonalcoholic fatty liver disease/Guidelines/Diagnosis/Treament/Indication引用本文复制引用
基金项目
国家自然科学基金(81970511)
国家自然科学基金(82270620)
出版年
2024
NETL
NSTL
万方数据