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成人非酒精性脂肪性肝病的自然病程与治疗

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
钟碧慧, 主任医师，教授

引言

非酒精性脂肪性肝病(nonalcoholic fatty liver disease, NAFLD)是指没有继发性肝脏脂肪沉积其他病因(如大量饮酒)时存在的肝脂肪变。NAFLD可能进展为肝硬化，并且可能是隐源性肝硬化的一个重要病因[1-4]。

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

定义

NAFL与NASH — NAFLD被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)两类。NAFL是指无炎症证据的肝脂肪变，而NASH是肝脂肪变伴有肝脏炎症，其在组织学上难以与酒精性脂肪性肝炎区分开[5,6]。已被用于描述NASH的其他术语包括伪酒精性肝炎、酒精样肝炎、脂肪肝肝炎、脂肪变性坏死和糖尿病性肝炎。

NAFLD活动度评分 — 区分NAFL与NASH的方法之一是进行肝活组织检查，并计算NAFLD活动度评分(NAFLD activity score, NAS)[7]。NAS是活组织检查中脂肪变性(0-3)、小叶炎症(0-2)、肝细胞气球样变(0-2)和纤维化(0-4)单项评分的总和[7]。NAS小于3分可诊断NAFL，3-4分可诊断为边缘性NASH，大于等于５分则可诊断为NASH。 (参见“慢性肝病的组织学评分系统”，关于‘非酒精性脂肪性肝病’一节)

自然病程

NAFLD患者可能最终进展为肝硬化。当单纯脂肪变性进展为脂肪性肝炎并随后纤维化时，出现肝硬化。在隐源性肝硬化患者中，多达70%的患者存在NAFLD的危险因素[1,4]。尽管多项研究已评估了NAFLD患者病情进展的风险，但得出的研究结果各异，NAFLD患者发生进展期纤维化的风险尚不明确[3,4,8-19]。然而，肝活检结果提示单纯脂肪变性患者发生显著肝纤维化的风险极低，而NASH患者发生显著纤维化风险则较高[20]。此外，部分肝纤维化患者可出现纤维化的消退[8-10]。

                          

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Literature review current through: 2017-06 . | This topic last updated: 2016-11-08.
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