非酒精性脂肪性肝病无创诊断研究进展

非酒精性脂肪性肝病是全球最常见的慢性肝病。据估计,全球约25%的成年人患有非酒精性脂肪性肝病,且患病率逐年增加。非酒精性脂肪性肝病的疾病谱涵盖非酒精性脂肪肝、非酒精性脂肪性肝炎、非酒精性脂肪性肝炎相关纤维化、肝硬化和肝细胞癌。肝活检作为非酒精性脂肪性肝病诊断和分期的“金标准”,因有创性、取样变异和评价不一致等局限性限制了其广泛应用。随着进展为非酒精性脂肪性肝炎的患者数量增加,特别是疾病严重程度较重的病人增多,临床上迫切需要有效治疗药物,也迫切需要开发无创标志物来筛查、诊断、监测患者和判断疗效。对非酒精性脂肪性肝病的无创诊断研究进展进行综述,包括对脂肪变的评估、非酒精性脂肪性肝炎的诊断和纤维化的评估。     

非酒精性脂肪性肝炎诊断研究进展

非酒精性脂肪性肝病是一种慢性非传染性疾病。近年来其患病率和发病率不断增高,发病年龄也出现低年龄化趋势,该疾病已取代慢性乙型肝炎成为第一大慢性肝脏疾病。重点综述非酒精性脂肪性肝病中的非酒精性脂肪性肝炎的诊断研究进展,介绍非酒精性脂肪性肝炎的临床病史、病理学诊断、非侵入方法诊断,为临床诊断提供参考。     

非酒精性脂肪性肝病的药物治疗进展

随着生活水平的不断提高，脂肪性肝病已成为常见病和多发病，尤其是非酒精性脂肪性肝病的患病率日益增加，趋于超过病毒性肝炎和酒精性肝病，成为全球普遍关注的医学问题和社会问题。非酒精性脂肪性肝病（Non—alcoholic fatty liver disease，NAFLD）简称脂肪肝，是一类肝组织学改变与酒精性肝病类似但无过量饮酒史的临床病理综合征。其病理改变是以肝实质细胞脂肪变性和脂肪贮积为特征。     

非酒精性脂肪性肝病不容忽视

非酒精性脂肪性肝病是一种与胰岛素抵抗及遗传等密切相关的代谢应激性肝脏损伤,其病理学改变与酒精性肝病相似,但患者无过量饮酒史。非酒精性脂肪性肝病包括：非酒精性单纯性脂肪肝、非酒精性脂肪性肝炎及其相关肝硬化和肝细胞癌。     

非酒精性脂肪性肝炎内科综合治疗临床观察

随着生活水平的提高,脂肪肝尤其是非酒精性脂肪性肝病日益增加,非酒精性脂肪性肝炎是非酒精性脂肪性肝病中的一种临床类型。我们探讨内科综合治疗对非酒精性脂肪性肝炎的疗效。1资料与方法1.1一般资料2006年3月至2007年6月消化科就诊的非酒精性脂肪性肝炎患者,将患者采取随机编     

非酒精性脂肪性肝病的治疗进展

目前全球非酒精性脂肪性肝病的发病率增加,并与代谢综合征,尤其是肥胖及糖尿病密切相关.越来越多的证据表明,胰岛素抵抗是代谢综合征患者发生脂肪性肝炎的关键病因,其可增加脂肪变性及肝脏游离脂肪酸聚集,刺激氧化应激反应,促进脂质过氧化及炎症细胞因子产生.非酒精性脂肪性肝病的治疗以改善代谢综合征为主,尚缺乏已验证的疗效理想的治疗药物.近年来随着对其发病机制的深入理解,一些尚处于动物试验及前期临床研究的新药值得关注.     

从典型病例谈NAFLD的诊断和治疗

非酒精性脂肪性肝病（NAFLD）是指除外过量饮酒和其他明确的损肝因素所致的肝细胞内脂肪沉积,其疾病谱包括非酒精性单纯性脂肪肝（nonalcoholic simple fatty liver,NAFL）、非酒精性脂肪性肝炎（nonalcoholic steatohepatitis,NASH）及其相关肝硬化和肝细胞癌。非酒精性脂肪性肝病的发病与肥胖、糖尿病、代谢综合征密切相关,被认为是代谢综合征在肝脏的表现。     

非酒精性脂肪性肝病的综合治疗

非酒精性脂肪性肝病(NAFLD)是代谢综合征在肝脏的表现,其疾病谱包括非酒精性单纯性脂肪肝、非酒精性脂肪性肝炎(NASH)和肝硬化.其治疗应为综合性下预,包括通过调整生活方式、药物及手术治疗等方法改善胰岛素抵抗,减少易致肝脏损伤的因素,必要时可应用保肝抗炎药物,终末期NAFLD患者需行肝移植术.     

脂联素与非酒精性脂肪性肝病

非酒精性脂肪性肝病（non—alcoholic fatty liver disease，NAFLD）是临床常见肝病之一，包括从单纯的肝脂肪变性到非酒精性脂肪性肝炎，以及可最终发展为肝硬化的一组肝脏慢性临床病理综合征，其病因及发病机理至今尚未完全阐明。脂联素为新发现的一种脂肪细胞因子，具有增加胰岛素敏感性、抗炎、增加葡萄糖摄取、促进脂肪酸氧化等作用，已有研究认为与NAFLD关系密切，本文就此作一综述。     

非酒精性脂肪肝的诊疗现状及展望

<正>非酒精性脂肪肝(NAFL),又称非酒精性脂肪性肝病(NAFLD),是近来被广泛认识的慢性肝病,是一种无过量饮酒史、肝实质细胞脂肪变性和脂肪贮积为特征的临床病理综合征。非酒精性脂肪性肝炎(NASH)可逐渐进展为肝硬化、肝癌等终末期肝病,已成为目前仅次于慢性病毒性肝     

Novel findings for the development of drug therapy for various liver diseases: Liver microsomal triglyceride transfer protein activator may be a possible therapeutic agent in non-alcoholic steatohepatitis

The factors involved in the progression of non-alcoholic fatty liver (NAFL) to non-alcoholic steatohepatitis (NASH) are not fully understood and thus it is urgently needed to elucidate these factors. Steatosis is not causal in the development of NASH, but rather it sensitizes the liver to the damaging effects of second hits such that stressors innocuous to a healthy liver lead to the development of NASH in the steatotic liver. In the previous study, most of the hepatic lipid metabolite profiles were similar in the NAFL and NASH groups. However, very-low-density lipoprotein (VLDL) synthesis, especially hepatic microsomal triglyceride transfer protein (MTP) mRNA expression, was impaired in the NASH group. Moreover, NASH showed significantly higher incidence of minor alley appearance compared with NAFL, indicating the possibility of association between NASH pathogenesis and decreased congenital MTP activity. MTP is one of the enzymes that transfer triglycerides to nascent apolipoprotein B, producing VLDL and removing lipid from the hepatocyte. A growing body of literature suggests that the measurement of hepatic MTP expression may be helpful for diagnosis; and moreover, hepatic MTP activator may be a possible therapeutic agent for the treatment of NASH.     

Promising therapies for treatment of nonalcoholic steatohepatitis

Introduction: Non-alcoholic fatty liver disease (NAFLD) has become the most common etiology for abnormal aminotransferase levels and chronic liver disease. Its growing prevalence is largely linked to the presence of metabolic syndrome, particularly diabetes and insulin resistance. It is estimated that 60–80% of the type 2 diabetic population has NAFLD. NAFLD encompasses a range of conditions ranging from simple steatosis to non-alcoholic steatohepatitis (NASH). A subset of patients with hepatic steatosis progress to NASH, while 15–20% of patients with NASH develop cirrhosis. This progression is thought to be multifactorial, and there are currently no FDA-approved medications for the treatment of NASH.

Areas covered: We review drugs currently in Phase II and III clinical trials for treatment of NAFLD and NASH, including their mechanisms of action, relationship to the pathophysiology of NASH, and rationale for their development.

Expert opinion: The treatment of NASH is complex and necessitates targeting a number of different pathways. Combination therapy, preferably tailored toward the disease stage and severity, will be needed to achieve maximum therapeutic effect. With multiple agents currently being developed, there may soon be an ability to effectively slow or even reverse the disease process in many NAFLD/NASH patients.     

灵芝三萜对小鼠非酒精性脂肪肝的治疗作用

目的研究灵芝三萜（ganoderma triterpene,GT）对小鼠非酒精性脂肪肝的治疗作用。方法以复方高脂饲料连续喂养小鼠5周,建立非酒精性脂肪肝小鼠模型。除正常对照组的8只小鼠外,将造模成功小鼠40只随机分为5组,分别为模型对照组、阳性药物组（壳脂胶囊100mg·kg^-1,1次·d^-1）、GT高、中、低（200,100,50mg·kg^-1,1次·d^-1）剂量组。连续给药6周后,检测血清和肝脏中生化指标,做肝脏组织病理学检查。结果非酒精性脂肪肝小鼠经GT治疗后,GT高、中剂量组都表现出降低非酒精性脂肪肝小鼠血清中总胆固醇（TC）、甘油三脂（TG）含量和天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）活性的作用,降低非酒精性脂肪肝小鼠肝脏中TG、TC、丙二醛（MDA）含量,升高超氧化物岐化酶（SOD）活力的作用（P〈0．05或P〈0．01）;组织病理学检查发现脂肪肝程度明显减轻,肝细胞坏死程度减轻。结论GT对高脂饲料所致非酒精性脂肪肝小鼠具有保肝调脂作用。     

Present and emerging pharmacotherapies for non-alcoholic steatohepatitis in adults

Introduction: Multiple parallel factors are implicated in the pathogenesis and progression of non-alcoholic fatty liver disease (NAFLD)/non-alcoholic steatohepatitis (NASH). Currently recommended therapies for NASH include vitamin E and pioglitazone, besides dietary and lifestyle changes.

Areas covered: This review focuses on the clinical development of several emerging drugs for the treatment of NASH and the impact of these drugs on current treatment standards.

Expert opinion: Four drug classes (FXR agonists, CCR2/CCR5 antagonists, ASK1 inhibitors, and PPARα/δ agonists) have moved into phase 3 trials for their investigation as NASH treatments. Results from phase 2 trials of other therapeutic agents with other pharmacological actions are also expected. The importance of combinational therapies with synergistic benefits engaging different targets, is now understood. Furthermore, studies have determined that the Mediterranean diet is beneficial for patients with NAFLD, while the traditional Okinawan diet is also considered useful. In the future, it will be important to establish new biomarkers to assess NAFLD activity, furthermore non-invasive diagnostic methods will promote the development of new drugs for NASH.     

天然免疫与非酒精性脂肪肝病

肝脏中大量的巨噬细胞、自然杀伤细胞(natural killer,NK)、自然杀伤T细胞(natural killer T cell,NKT)等构成了天然免疫系统.这一系统细胞功能紊乱,发生Th-1极化,使促炎症因子产生增多,促进了非酒精性脂肪性肝炎(nonalcoholic steatohepatitis,NASH)的形成;肝脏持续的暴露于这些炎症因子,可以促进多种促纤维化因子产生,但Th-2细胞因子分泌的不足, 使NASH进一步发展为肝硬化的现象却相对比较少见.本文就肝脏天然免疫系统在非酒精性脂肪肝病(nonalcoholic fatty liver disease, NAFLD)中的调节机制作一综述.     

治疗脂肪肝的药物临床应用评价

脂肪肝是由多种原因引起的肝细胞内脂肪堆积过多而导致的病变。脂肪肝已成为仅次于病毒性肝炎的第二大肝病,并被认为是隐蔽性肝硬化的常见原因之一。脂肪肝可分为酒精性脂肪肝和非酒精性脂肪肝。目前,临床上并没有针对脂肪肝的特效药物,多采用药物对症治疗的方法。本文对近年来脂肪肝的治疗药物的临床应用进行总结。