UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

成人非酒精性脂肪性肝病的流行病学、临床特征和诊断

Authors
Sunil G Sheth, MD
Sanjiv Chopra, MD, MACP
Section Editor
Keith D Lindor, MD
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF
Translators
闫秀娥, 副主任医师，副教授

引言

非酒精性脂肪性肝病(nonalcoholic fatty liver disease, NAFLD)是指无其他原因(如大量饮酒)引起继发性肝脂沉积时，存在肝脂肪变。NAFLD可能进展为肝硬化，也很可能是隐源性肝硬化的一个重要原因[1-4]。

本专题将总结NAFLD的流行病学、临床特征和诊断。NAFLD的发病机制、自然病程和治疗将单独讨论。 (参见“非酒精性脂肪性肝病的发病机制”和“成人非酒精性脂肪性肝病的自然病程与治疗”)

定义

NAFLD患者存在肝脂肪变，伴或不伴炎症和纤维化。此外，不存在肝脂肪变的继发性原因。 (参见下文‘鉴别诊断’)

NAFLD可细分为非酒精性脂肪肝(nonalcoholic fatty liver, NAFL)和非酒精性脂肪性肝炎(nonalcoholic steatohepatitis, NASH)。NAFL中，存在无明显炎症证据的肝脂肪变；而NASH中，存在伴有肝脏炎症肝脂肪变，且在组织学上可能无法与酒精性脂肪性肝炎相区分[5,6]。用于描述NASH的其他术语包括：假性酒精性肝炎、酒精样肝炎、脂肪肝肝炎、脂肪坏死和糖尿病性肝炎。 (参见下文‘组织学表现’和‘NAFLD活动评分’)

流行病学

患病率 — NAFLD在全球均有发病，是西方工业化国家最常见的肝病，在这些国家NAFLD的主要危险因素包括向心性肥胖、2型糖尿病、血脂异常和代谢综合征均很常见[7]。在美国，研究报道NAFLD的患病率为10%-46%，大多数基于肝活检的研究报道NASH的患病率为3%-5%[8-10]。全球来看，NAFLD的患病率为6%-35%(中位数为20%)。

                         

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: 2017-06 . | This topic last updated: 2017-01-26.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Caldwell SH, Oelsner DH, Iezzoni JC, et al. Cryptogenic cirrhosis: clinical characterization and risk factors for underlying disease. Hepatology 1999; 29:664.
  2. Caldwell SH, Crespo DM. The spectrum expanded: cryptogenic cirrhosis and the natural history of non-alcoholic fatty liver disease. J Hepatol 2004; 40:578.
  3. Browning JD, Kumar KS, Saboorian MH, Thiele DL. Ethnic differences in the prevalence of cryptogenic cirrhosis. Am J Gastroenterol 2004; 99:292.
  4. Poonawala A, Nair SP, Thuluvath PJ. Prevalence of obesity and diabetes in patients with cryptogenic cirrhosis: a case-control study. Hepatology 2000; 32:689.
  5. Ludwig J, Viggiano TR, McGill DB, Oh BJ. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clin Proc 1980; 55:434.
  6. Sheth SG, Gordon FD, Chopra S. Nonalcoholic steatohepatitis. Ann Intern Med 1997; 126:137.
  7. Younossi ZM, Stepanova M, Afendy M, et al. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. Clin Gastroenterol Hepatol 2011; 9:524.
  8. Williams CD, Stengel J, Asike MI, et al. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology 2011; 140:124.
  9. Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther 2011; 34:274.
  10. Lazo M, Hernaez R, Eberhardt MS, et al. Prevalence of nonalcoholic fatty liver disease in the United States: the Third National Health and Nutrition Examination Survey, 1988-1994. Am J Epidemiol 2013; 178:38.
  11. Browning JD, Szczepaniak LS, Dobbins R, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 2004; 40:1387.
  12. Amarapurkar DN, Hashimoto E, Lesmana LA, et al. How common is non-alcoholic fatty liver disease in the Asia-Pacific region and are there local differences? J Gastroenterol Hepatol 2007; 22:788.
  13. Ruhl CE, Everhart JE. Fatty liver indices in the multiethnic United States National Health and Nutrition Examination Survey. Aliment Pharmacol Ther 2015; 41:65.
  14. Falck-Ytter Y, Younossi ZM, Marchesini G, McCullough AJ. Clinical features and natural history of nonalcoholic steatosis syndromes. Semin Liver Dis 2001; 21:17.
  15. Lee RG. Nonalcoholic steatohepatitis: a study of 49 patients. Hum Pathol 1989; 20:594.
  16. Powell EE, Cooksley WG, Hanson R, et al. The natural history of nonalcoholic steatohepatitis: a follow-up study of forty-two patients for up to 21 years. Hepatology 1990; 11:74.
  17. Diehl AM, Goodman Z, Ishak KG. Alcohollike liver disease in nonalcoholics. A clinical and histologic comparison with alcohol-induced liver injury. Gastroenterology 1988; 95:1056.
  18. Angulo P, Keach JC, Batts KP, Lindor KD. Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology 1999; 30:1356.
  19. Matteoni CA, Younossi ZM, Gramlich T, et al. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 1999; 116:1413.
  20. Cortez-Pinto H, Camilo ME, Baptista A, et al. Non-alcoholic fatty liver: another feature of the metabolic syndrome? Clin Nutr 1999; 18:353.
  21. Laurin J, Lindor KD, Crippin JS, et al. Ursodeoxycholic acid or clofibrate in the treatment of non-alcohol-induced steatohepatitis: a pilot study. Hepatology 1996; 23:1464.
  22. Bacon BR, Farahvash MJ, Janney CG, Neuschwander-Tetri BA. Nonalcoholic steatohepatitis: an expanded clinical entity. Gastroenterology 1994; 107:1103.
  23. Arun J, Clements RH, Lazenby AJ, et al. The prevalence of nonalcoholic steatohepatitis is greater in morbidly obese men compared to women. Obes Surg 2006; 16:1351.
  24. Marchesini G, Bugianesi E, Forlani G, et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology 2003; 37:917.
  25. Chitturi S, Abeygunasekera S, Farrell GC, et al. NASH and insulin resistance: Insulin hypersecretion and specific association with the insulin resistance syndrome. Hepatology 2002; 35:373.
  26. Weston SR, Leyden W, Murphy R, et al. Racial and ethnic distribution of nonalcoholic fatty liver in persons with newly diagnosed chronic liver disease. Hepatology 2005; 41:372.
  27. Wanless IR, Lentz JS. Fatty liver hepatitis (steatohepatitis) and obesity: an autopsy study with analysis of risk factors. Hepatology 1990; 12:1106.
  28. Marchesini G, Brizi M, Morselli-Labate AM, et al. Association of nonalcoholic fatty liver disease with insulin resistance. Am J Med 1999; 107:450.
  29. Cello JP, Grendell JH. The liver in systemic conditions. In: Hepatology, Zakim D, Boyer TD (Eds), WB Saunders, Philadelphia 1990. p.1428.
  30. Pinto HC, Baptista A, Camilo ME, et al. Nonalcoholic steatohepatitis. Clinicopathological comparison with alcoholic hepatitis in ambulatory and hospitalized patients. Dig Dis Sci 1996; 41:172.
  31. Itoh S, Yougel T, Kawagoe K. Comparison between nonalcoholic steatohepatitis and alcoholic hepatitis. Am J Gastroenterol 1987; 82:650.
  32. Fracanzani AL, Valenti L, Bugianesi E, et al. Risk of severe liver disease in nonalcoholic fatty liver disease with normal aminotransferase levels: a role for insulin resistance and diabetes. Hepatology 2008; 48:792.
  33. Stepanova M, Younossi ZM. Independent association between nonalcoholic fatty liver disease and cardiovascular disease in the US population. Clin Gastroenterol Hepatol 2012; 10:646.
  34. Ruhl CE, Everhart JE. Relationship of non-alcoholic fatty liver disease with cholecystectomy in the US population. Am J Gastroenterol 2013; 108:952.
  35. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology 2012; 142:1592.
  36. Amarapurkar D, Kamani P, Patel N, et al. Prevalence of non-alcoholic fatty liver disease: population based study. Ann Hepatol 2007; 6:161.
  37. Oliva MR, Mortele KJ, Segatto E, et al. Computed tomography features of nonalcoholic steatohepatitis with histopathologic correlation. J Comput Assist Tomogr 2006; 30:37.
  38. Mofrad P, Contos MJ, Haque M, et al. Clinical and histologic spectrum of nonalcoholic fatty liver disease associated with normal ALT values. Hepatology 2003; 37:1286.
  39. Noguchi H, Tazawa Y, Nishinomiya F, Takada G. The relationship between serum transaminase activities and fatty liver in children with simple obesity. Acta Paediatr Jpn 1995; 37:621.
  40. Charatcharoenwitthaya P, Lindor KD, Angulo P. The spontaneous course of liver enzymes and its correlation in nonalcoholic fatty liver disease. Dig Dis Sci 2012; 57:1925.
  41. Cohen JA, Kaplan MM. The SGOT/SGPT ratio--an indicator of alcoholic liver disease. Dig Dis Sci 1979; 24:835.
  42. Sorbi D, Boynton J, Lindor KD. The ratio of aspartate aminotransferase to alanine aminotransferase: potential value in differentiating nonalcoholic steatohepatitis from alcoholic liver disease. Am J Gastroenterol 1999; 94:1018.
  43. McCullough AJ. The clinical features, diagnosis and natural history of nonalcoholic fatty liver disease. Clin Liver Dis 2004; 8:521.
  44. Kowdley KV, Belt P, Wilson LA, et al. Serum ferritin is an independent predictor of histologic severity and advanced fibrosis in patients with nonalcoholic fatty liver disease. Hepatology 2012; 55:77.
  45. Schwenzer NF, Springer F, Schraml C, et al. Non-invasive assessment and quantification of liver steatosis by ultrasound, computed tomography and magnetic resonance. J Hepatol 2009; 51:433.
  46. Lonardo A, Bellini M, Tondelli E, et al. Nonalcoholic steatohepatitis and the "bright liver syndrome": should a recently expanded clinical entity be further expanded? Am J Gastroenterol 1995; 90:2072.
  47. Hernaez R, Lazo M, Bonekamp S, et al. Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis. Hepatology 2011; 54:1082.
  48. Mottin CC, Moretto M, Padoin AV, et al. The role of ultrasound in the diagnosis of hepatic steatosis in morbidly obese patients. Obes Surg 2004; 14:635.
  49. de Moura Almeida A, Cotrim HP, Barbosa DB, et al. Fatty liver disease in severe obese patients: diagnostic value of abdominal ultrasound. World J Gastroenterol 2008; 14:1415.
  50. Rofsky NM, Fleishaker H. CT and MRI of diffuse liver disease. Semin Ultrasound CT MR 1995; 16:16.
  51. Szczepaniak LS, Nurenberg P, Leonard D, et al. Magnetic resonance spectroscopy to measure hepatic triglyceride content: prevalence of hepatic steatosis in the general population. Am J Physiol Endocrinol Metab 2005; 288:E462.
  52. Cho CS, Curran S, Schwartz LH, et al. Preoperative radiographic assessment of hepatic steatosis with histologic correlation. J Am Coll Surg 2008; 206:480.
  53. Springer F, Machann J, Claussen CD, et al. Liver fat content determined by magnetic resonance imaging and spectroscopy. World J Gastroenterol 2010; 16:1560.
  54. Cowin GJ, Jonsson JR, Bauer JD, et al. Magnetic resonance imaging and spectroscopy for monitoring liver steatosis. J Magn Reson Imaging 2008; 28:937.
  55. Neuschwander-Tetri BA, Clark JM, Bass NM, et al. Clinical, laboratory and histological associations in adults with nonalcoholic fatty liver disease. Hepatology 2010; 52:913.
  56. Saadeh S, Younossi ZM, Remer EM, et al. The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology 2002; 123:745.
  57. Neuschwander-Tetri BA, Caldwell SH. Nonalcoholic steatohepatitis: summary of an AASLD Single Topic Conference. Hepatology 2003; 37:1202.
  58. Brunt EM, Tiniakos DG. Alcoholic and nonalcoholic fatty liver disease. In: Surgical pathology of the GI tract, liver, biliary tract and pancreas, 2nd ed., Odze RD, Goldblum JR. (Eds), Elsevier, Philadelphia 2009. p.1007.
  59. Brunt EM, Tiniakos DG. Histopathology of nonalcoholic fatty liver disease. World J Gastroenterol 2010; 16:5286.
  60. Brunt EM. Nonalcoholic steatohepatitis: definition and pathology. Semin Liver Dis 2001; 21:3.
  61. Brunt EM. Pathology of fatty liver disease. Mod Pathol 2007; 20 Suppl 1:S40.
  62. Abrams GA, Kunde SS, Lazenby AJ, Clements RH. Portal fibrosis and hepatic steatosis in morbidly obese subjects: A spectrum of nonalcoholic fatty liver disease. Hepatology 2004; 40:475.
  63. Brunt EM, Ramrakhiani S, Cordes BG, et al. Concurrence of histologic features of steatohepatitis with other forms of chronic liver disease. Mod Pathol 2003; 16:49.
  64. Kleiner DE, Brunt EM, Van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005; 41:1313.
  65. Liangpunsakul S, Chalasani N. What should we recommend to our patients with NAFLD regarding alcohol use? Am J Gastroenterol 2012; 107:976.
  66. Dunn W, Angulo P, Sanderson S, et al. Utility of a new model to diagnose an alcohol basis for steatohepatitis. Gastroenterology 2006; 131:1057.