非酒精性脂肪性肝病的治疗进展

牛海艳; 李海; 丁玉平

doi:10.3969/j.issn.1001-5256.2018.02.048

非酒精性脂肪性肝病的治疗进展

DOI: 10.3969/j.issn.1001-5256.2018.02.048

中国人民武装警察部队后勤学院附属医院肝胆胰脾科(消化二科)

基金项目:

武警后勤学院博士启动基金(WHB201517)；

详细信息

中图分类号: R575.5
计量
- 文章访问数: 2542
- HTML全文浏览量: 39
- PDF下载量: 426
- 被引次数: 0
出版历程
- 出版日期: 2018-02-20

Advances in the treatment of nonalcoholic fatty liver disease

Department of Hepatopancreatobiliary and Splenic Medicine, The Affiliated Hospital of Logistics University of Chinese People′s Armed Police Forces

Research funding:

摘要

摘要:
非酒精性脂肪性肝病(NAFLD)在我国的发病率逐年攀升,已是严重影响我国居民健康的常见慢性疾病。介绍了生活方式的干预在NAFLD治疗中的地位,简述了药物在NAFLD治疗中的种类与价值,总结了改善肠道菌群在NAFLD治疗中的方法与途径,分析了外科手术干预在NAFLD治疗中的临床获益与经济效价。指出加强对NAFLD患者的有效管理可能是未来对该疾病治疗的一个新研究方向。
- 脂肪肝 /
- 治疗 /
- 综述
Abstract:
The incidence rate of nonalcoholic fatty liver disease (NAFLD) has been increasing year by year in China, and NAFLD has become one of the common chronic diseases that affect the health of Chinese residents.This article introduces the role of lifestyle intervention, reviews the types of drugs used in the treatment of NAFLD and their value, summarizes the methods and approaches for improving intestinal flora, and analyzes the clinical and economic benefits of surgical intervention in the treatment of NAFLD.It is pointed out that strengthening the effective management of patients with NAFLD may be a new research direction in the future for the treatment of this disease.
- fatty liver /
- therapy /
- review

HTML全文

参考文献(49)

[1]CALDWELL S, ARGO C.The natural history of non-alcoholic fatty liver disease[J].Dig Dis, 2010, 28 (1) :162-168.

[2]BYRNE CD, TARGHER G.NAFLD:a multisystem disease[J].J Hepatol, 2015, 62 (Suppl 1) :s47-s64.

[3]VILAR-GOMEZ E, MARTINEZ-PEREZ Y, CALZADILLABERTOT L, et al.Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis[J].Gastroenterology, 2015, 149 (2) :367-378.

[4]HANNAH WN JR, HARRISON SA.Lifestyle and Dietary interventions in the management of nonalcoholic fatty liver disease[J].Dig Dis Sci, 2016, 61 (5) :1365-1374.

[5]JUMP DB, DEPNER CM, TRIPATHY S, et al.Potential for dietaryω-3fatty acids to prevent nonalcoholic fatty liver disease and reduce the risk of primary liver cancer[J].Adv Nutr, 2015, 6 (6) :694-702.

[6]MARKOVA M, PIVOVAROVA O, HORNEMANN S, et al.Isocaloric diets high in animal or plant protein reduce liver fat and inflammation in individuals with type 2 diabetes[J].Gastroenterology, 2017, 152 (3) :571-585.

[7]MARTINEZ-GONZALEZ MA, MARTIN-CALVO N.Mediterranean diet and life expectancy;beyond olive oil, fruits, and vegetables[J].Curr Opin Clin Nutr Metab Care, 2016, 19 (6) :401-407.

[8]KONTOGIANNI MD, TILELI N, MARGARITI A, et al.Adherence to the Mediterranean diet is associated with the severity of non-alcoholic fatty liver disease[J].Clin Nutr, 2014, 33 (4) :678-683.

[9]WIJARNPREECHA K, THONGPRAYOON C, UNGPRASERT P.Coffee consumption and risk of nonalcoholic fatty liver disease:a systematic review and meta-analysis[J].Eur J Gastroenterol Hepatol, 2017, 29 (2) :e8-e12.

[10]Group of Fatty Liver and Alcoholic Liver Diseases, Society of Hepatology, Chinese Medical Association.Guidelines for management of non-alcoholic fatty liver disease[J].J Clin Hepatol, 2010, 26 (2) :120-124. (in Chinese) 中华医学会肝脏病学分会脂肪肝和酒精性肝病学组.非酒精性脂肪性肝病诊疗指南[J].临床肝胆病杂志, 2010, 26 (2) :120-124.

[11]ORCI LA, GARIANI K, OLDANI G, et al.Exercise-based interventions for nonalcoholic fatty liver disease:a Meta-analysis and Meta-regression[J].Clin Gastroenterol Hepatol, 2016, 14 (10) :1398-1411.

[12]KISTLER KD, BRUNT EM, CLARK JM, et al.Physical activity recommendations, exercise intensity, and histological severity of nonalcoholic fatty liver disease[J].Am J Gastroenterol, 2011, 106 (3) :460-468.

[13]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[J].Hepatology, 2017.[Epub ahead of print]

[14]RATZIU V, HARRISON SA, FRANCQUE S, et al.Elafibranor, an agonist of the peroxisome proliferator-activated receptor-αand-δ, induces resolution of nonalcoholic steatohepatitis without fibrosis worsening[J].Gastroenterology, 2016, 150 (5) :1147-1159.

[15]SAID A, AKHTER A.Meta-analysis of randomized controlled trials of pharmacologic agents in non-alcoholic steatohepatitis[J].Ann Hepatol, 2017, 16 (4) :538-547.

[16]SATHYANARAYANA P, JOGI M, MUTHUPILLAI R, et al.Effects of combined exenatide and pioglitazone therapy on hepatic fat content in type 2 diabetes[J].Obesity (Silver Spring) , 2011, 19 (12) :2310-2315.

[17]OHKI T, ISOGAWA A, IWAMOTO M, et al.The effectiveness of liraglutide in nonalcoholic fatty liver disease patients with type 2 diabetes mellitus compared to sitagliptin and pioglitazone[J].Scientific World J, 2012, 2012:496453.

[18]IWASAKI T, YONEDA M, INAMORI M, et al.Sitagliptin as a novel treatment agent for non-alcoholic Fatty liver disease patients with type 2 diabetes mellitus[J].Hepatogastroenterology, 2011, 58 (112) :2103-2105.

[19]CUI J, PHILO L, NGUYEN P, et al.Sitagliptin vs.placebo for non-alcoholic fatty liver disease:a randomized controlled trial[J].J Hepatol, 2016, 65 (2) :369-376.

[20]WANG CJ, HUANG RX, JIANG YS, et al.Effect of saxagliptin on nonalcoholic fatty liver in patients with diabetes mellitus[J].Chongqing Med, 2017, 46 (11) :1490-1491, 1494. (in Chinese) 王成剑, 黄荣曦, 姜英松, 等.DPP-4抑制剂沙格列汀对糖尿病非酒精性脂肪肝的作用研究[J].重庆医学, 2017, 46 (11) :1490-1491, 1494

[21]de KEYSER CE, KOEHLER EM, SCHOUTEN JN, et al.Statin therapy is associated with a reduced risk of non-alcoholic fatty liver in overweight individuals[J].Dig Liver Dis, 2014, 46 (8) :720-725.

[22]KARGIOTIS K, ATHYROS VG, GIOULEME O, et al.Resolution of non-alcoholic steatohepatitis by rosuvastatin monotherapy in patients with metabolic syndrome[J].World J Gastroenterol, 2015, 21 (25) :7860-7868.

[23]DONGIOVANNI P, PETTA S, MANNISTO V, et al.Statin use and non-alcoholic steatohepatitis in at risk individuals[J].J Hepatol, 2015, 63 (3) :705-712.

[24]CHANG BX, LI BS, ZOU ZS.An excerpt of EASL-EASDEASO clinical practice guidelines for the management of non-alcoholic fatty liver disease (2016) [J].J Clin Hepatol, 2016, 32 (8) :1450-1454. (in Chinese) 常彬霞, 李保森, 邹正升.《2016年欧洲肝病学会、欧洲糖尿病学会和欧洲肥胖学会临床实践指南》摘译[J].临床肝胆病杂志, 2016, 32 (8) :1450-1454.

[25]ATHYROS VG, ALEXANDRIDES TK, BILIANOU H, et al.The use of statins alone, or in combination with pioglitazone and other drugs, for the treatment of non-alcoholic fatty liver disease/nonalcoholic steatohepatitis and related cardiovascular risk.An expert panel statement[J].Metabolism, 2017, 71:17-32.

[26]EL-HAGGAR SM, MOSTAFA TM.Comparative clinical study between the effect of fenofibrate alone and its combination with pentoxifylline on biochemical parameters and liver stiffness in patients with nonalcoholic fatty liver disease[J].Hepatol Int, 2015, 9 (3) :471-479.

[27]YU D, SHU XO, XIANG YB, et al.Higher dietary choline intake is associated with lower risk of nonalcoholic fatty liver in normalweight Chinese women[J].J Nutr, 2014, 144 (12) :2034-2040.

[28]ZHANG H, HAN J, ZHANG XL.An excerpt of the Japanese Society of Gastroenterology of evidence-based clinical practice guidelines for liver cirrhosis (2015) [J].J Clin Hepatol, 2016, 32 (9) :1659-1663. (in Chinese) 张红, 韩静, 张晓岚.《2015年日本胃肠病学会肝硬化循证医学临床实践指南》摘译[J].临床肝胆病杂志, 2016, 32 (9) :1659-1663

[29]NEUSCHWANDER-TETRI BA, LOOMBA R, SANYAL AJ, et al.Farnesoid X nuclear receptor ligand obeticholic acid for noncirrhotic, non-alcoholic steatohepatitis (FLINT) :a multicentre, randomised, placebo-controlled trial[J].Lancet, 2015, 385 (9972) :956-965.

[30]FRIEDMAN S, SANYAL A, GOODMAN Z, et al.Efficacy and safety study of cenicriviroc for the treatment of non-alcoholic steatohepatitis in adult subjects with liver fibrosis:CENTAUR Phase 2 b study design[J].Contemp Clin Trials, 2016, 47:356-365.

[31]ARAB JP, KARPEN SJ, DAWSON PA, et al.Bile acids and nonalcoholic fatty liver disease:Molecular insights and therapeutic perspectives[J].Hepatology, 2017, 65 (1) :350-362.

[32]ALTAMIRANO-BARRERA A, BARRANCO-FRAGOSO B, MNDEZ-SNCHEZ N.Management strategies for liver fibrosis[J].Ann Hepatol, 2017, 16 (1) :48-56.

[33]JING J, YU JF, ZHANG TF.Curative effect of Yerba Mate improving phlegm and blood stasis, and blood lipid level of NAFLD[J].Chin J Med Offic, 2017, 45 (7) :683-684. (in Chinese) 井静, 于京芳, 张铁峰.马黛茶改善非酒精性脂肪性肝病痰瘀互结证血脂水平疗效分析[J].临床军医杂志, 2017, 45 (7) :683-684.

[34]ZHU D, SUN TT, CHEN LY.Treatment of nonalcoholic fatty liver disease in Jingui Yaolue[J].Changchun Univ Chin Med, 2016, 32 (2) :423-425, 429. (in Chinese) 朱丹, 孙婷婷, 陈兰羽.《金匮要略》诸方治疗非酒精性脂防性肝病进展[J].长春中医药大学学报, 2016, 32 (2) :423-425, 429.

[35]LEUNG C, RIVERA L, FURNESS JB, et al.The role of the gut microbiota in NAFLD[J].Nat Rev Gastroenterol Hepatol, 2016, 13 (7) :412-425.

[36]XIAO L, YANG L.Gut microbiota and nonalcoholic fatty liver disease[J].J Clin Hepatol, 2017, 33 (4) :774-779. (in Chinese) 肖丽, 杨玲.肠道菌群与非酒精性脂肪性肝病的关系[J].临床肝胆病杂志, 2017, 33 (4) :774-779.

[37]BUSS C, VALLE-TOVO C, MIOZZO S, et al.Probiotics and synbiotics may improve liver aminotransferases levels in non-alcoholic fatty liver disease patients[J].Ann Hepatol, 2014, 13 (5) :482-488.

[38]GULLON B, GULLON P, TAVARIA FK, et al.Assessment of the prebiotic effect of quinoa and amaranth in the human intestinal ecosystem[J].Food Funct, 2016, 7 (9) :3782-3788.

[39]FUJISAKA S, USSAR S, CLISH C, et al.Antibiotic effects on gut microbiotaand metabolism are host dependent[J].J Clin Invest, 2016, 126 (12) :4430-4443.

[40]HU J, LUO H, JIANG Y, et al.Dietary capsaicin and antibiotics act synergistically to reduce non-alcoholic fatty liver disease induced by high fat diet in mice[J].Oncotarget, 2017, 8 (24) :38161-38175.

[41]COBBOLD JFL, ATKINSON S, MARCHESI JR, et al.Rifaximin in non-alcoholic steatohepatitis:an open-label pilot study[J].Hepatol Res, 2017.[Epub ahead of print]

[42]GOODRICH JK, WATERS JL, POOLE AC, et al.Human genetics shape the gut microbiome[J].Cell, 2014, 159 (4) :789-799.

[43]LI SS, ZHU A, BENES V, et al.Durable coexistence of donor and recipient strains after fecal microbiotatransplantation[J].Science, 2016, 352 (6285) :586-589.

[44]ZHOU D, PAN Q, SHEN F, et al.Total fecal microbiota transplantation alleviates high-fat diet-induced steatohepatitis in mice via beneficial regulation of gut microbiota[J].Sci Rep, 2017, 7 (1) :1529.

[45]HAFEEZ S, AHMED MH.Bariatric surgery as potential treatment for nonalcoholic fatty liver disease:a future treatment by choice or by chance?[J].J Obes, 2013, 2013:839275.

[46]BOWER G, TOMA T, HARLING L, et al.Bariatric surgery and non-alcoholic fatty liver disease:a systematic review of liver biochemistry and histology[J].Obes Surg, 2015, 25 (12) :2280-2289.

[47]KLEBANOFF MJ, COREY KE, CHHATWAL J, et al.Bariatric surgery for nonalcoholic steatohepatitis:a clinical and cost-effectiveness analysis[J].Hepatology, 2017, 65 (4) :1156-1164.

[48]BURRA P, GERMANI G.Orthotopic liver transplantation in nonalcoholic fatty liver disease patients[J].Rev Recent Clin Trials, 2014, 9 (3) :210-216.

[49]UNGER LW, HERAC M, STAUFER K, et al.The post-transplant course of patients undergoing liver transplantation for nonalcoholic steatohepatitis versus cryptogenic cirrhosis:a retrospective case-control study[J].Eur J Gastroenterol Hepatol, 2017, 29 (3) :309-316.

施引文献

资源附件(0)

访问统计