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代谢相关脂肪性肝病的内科治疗进展

刘素彤 苏凯奇 赵晨露 张丽慧 赵文霞

引用本文:
Citation:

代谢相关脂肪性肝病的内科治疗进展

DOI: 10.3969/j.issn.1001-5256.2021.04.048
基金项目: 

国家自然科学基金面上项目 (81473651);

河南省中医药科学研究专项课题 (2018JDZX005);

河南省中医药科学研究专项课题 (2019JDZX2051);

河南省科技攻关计划项目 (202102310495)

利益冲突声明:所有作者均声明不存在利益冲突。
作者贡献声明:刘素彤负责课题设计,资料分析,撰写论文;苏凯奇负责修改论文;赵晨霞、张丽慧负责参考文献格式修改;赵文霞负责拟定写作思路,指导撰写文章并最后定稿。
详细信息
    作者简介:

    刘素彤(1991—),女,在读博士,主要从事中医药防治脾胃肝胆疾病的临床和基础研究

    通信作者:

    赵文霞,zhao-wenxia@126.com

  • 中图分类号: R575.5

Research advances in medical treatment of metabolic associated fatty liver disease

  • 摘要: 代谢相关脂肪性肝病(MAFLD)是目前全球范围内最重要的肝病之一,其发病率呈逐年上升的趋势。总结了目前内科治疗MALFD的研究现状,其治疗方式包括生活方式的改变和个体化药物的治疗。其中生活方式的改变有饮食管理、运动干预、生物钟调整和心理干预,个体化药物治疗有胰岛素增敏剂、维生素E、减肥降脂药、保肝降酶药及中医药治疗等。同时,多学科协作的治疗方式是临床治疗MAFLD的大势所趋。

     

  • [1] LAZARUS JV, EKSTEDT M, MARCHESINI G, et al. A cross-sectional study of the public health response to non-alcoholic fatty liver disease in Europe[J]. J Hepatol, 2020, 72(1): 14-24. DOI: 10.1016/j.jhep.2019.08.027.
    [2] NAHUM MS, ALEJANDRO VR. Caveats for the implementation of global strategies against non-alcoholic fatty liver disease[J]. J Hepatol, 2020, 73(1): 212-214. DOI: 10.1016/j.jhep.2020.02.013.
    [3] National Workshop on Fatty Liver and Alcoholic Liver Disease, Chinese Society of Hepatology, Chinese Medical Association. Guidelines of prevention and treatment for nonalcoholic fatty liver disease: A 2018 update[J]. J Clin Hepatol, 2018, 34(5): 947-957. DOI: 10.3969/j.issn.1001-5256.2018.05.007.

    中华医学会肝病学分会脂肪肝和酒精性肝病学组. 非酒精性脂肪性肝病防治指南(2018年更新版)[J]. 临床肝胆病杂志, 2018, 34(5): 947-957. DOI: 10.3969/j.issn.1001-5256.2018.05.007.
    [4] VLAD R, MARWAN G, MANURL RG, et al. Recommendations for management and treatment of nonalcoholic steatohepatitis[J]. Transplantation, 2019, 103(1): 28-38. DOI: 10.1097/TP.0000000000002483.
    [5] JNAGA C, ZOBAIR Y, JOEL EL, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases[J]. Hepatology, 2018, 67(1): 328-357. DOI: 10.1002/hep.29367.
    [6] JESSICA G, LEFTERIS F, CHIRS D, et al. Non-alcoholic fatty liver disease (NAFLD): Summary of NICE guidance[J]. BMJ, 2016, 354: i4428. DOI: 10.1136/bmj.i4428.
    [7] MARY ER, ARUN JS. Management of NAFLD: A stage-based approach[J]. Nat Rev Gastroenterol Hepatol, 2016, 13(4): 196-205. DOI: 10.1038/nrgastro.2016.3.
    [8] WILLIAM NH, STEPHEN AH. Noninvasive imaging methods to determine severity of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis[J]. Hepatology, 2016, 64(6): 2234-2243. DOI: 10.1002/hep.28699.
    [9] The Lancet Gastroenterology Hepatology. Headway and hurdles in non-alcoholic fatty liver disease[J]. Lancet Gastroenterol Hepatol, 2020, 5(2): 93. DOI: 10.1016/S2468-1253(19)30429-7.
    [10] YANG Y, ZHAO Y, LI WZ, et al. Emerging targets and potential therapeutic agents in non-alcoholic fatty liver disease treatment[J]. Eur J Med Chem, 2020, 197: 112311. DOI: 10.1016/j.ejmech.2020.112311.
    [11] FAN JG, GAO HX. Role of diet and nutritional management in non-alcoholic fatty liver disease[J]. J Gastroenterol Hepatol, 2013, Suppl 4: 81-87. DOI: 10.1111/jgh.12244.
    [12] MIGUEL MG, GORKA B. Mediterranean diet as the ideal model for preventing non-alcoholic fatty liver disease (NAFLD)[J]. Hepatobiliary Surg Nutr, 2020, 9(3): 379-381. DOI: 10.21037/hbsn.2019.11.13.
    [13] VINCENT WSW, RUTH SMC, GRACE LHW, et al. Community-based lifestyle modification programme for non-alcoholic fatty liver disease: A randomized controlled trial[J]. J Hepatol, 2013, 59(3): 536-542. DOI: 10.1016/j.jhep.2013.04.013.
    [14] National Workshop on Fatty Liver and Alcoholic Liver Disease, Chinese Society of Hepatology, Chinese Medical Association. Expert recommendations on standardized diagnosis and treatment for fatty liver disease (2019 revised edition)[J]. J Clin Hepatol, 2019, 35(11): 2426-2430. DOI: 10.3969/j. issn.1001-5256.2019.11.007.

    中华医学会肝病学分会脂肪肝和酒精性肝病学组. 脂肪性肝病诊疗规范化的专家建议(2019年修订版)[J]. 临床肝胆病杂志, 2019, 35(11): 2426-2430. DOI: 10. 3969/j. issn.1001-5256.2019.11.007.
    [15] FAIDON M, MADS FH, ARNE A. Diet and exercise in the prevention and treatment of type 2 diabetes mellitus[J]. Nat Rev Endocrinol, 2020, 16(10): 545-555. DOI: 10.1038/s41574-020-0381-5.
    [16] TORRES LF, COGLIATI B, OTTON R. Green tea prevents NAFLD by modulation of miR-34a and miR-194 expression in a high-fat diet mouse model[J]. Oxid Med Cell Longev, 2019, 2019: 1-18. DOI: 10.1155/2019/4168380.
    [17] DANIELA C, GIUSEPPE FM, ANTONIA T, et al. Protective role of coffee in non-alcoholic fatty liver disease (NAFLD)[J]. Dig Dis Sci, 2010, 55(11): 3200-3206. DOI: 10.1007/s10620-010-1143-3.
    [18] MANUEL RG, SHIRA ZS, MICHAEL T. Treatment of NAFLD with diet, physical activity and exercise[J]. J Hepatol, 2017, 67(4): 829-846. DOI: 10.1016/j.jhep.2017.05.016.
    [19] MARY ER. Nonalcoholic fatty liver disease: A systematic review[J]. JAMA, 2015, 313(22): 2263-2273. DOI: 10.1001/jama.2015.5370.
    [20] Chinese Society of Endocrinology, Chinese Medical Association. Consensus for diagnosis and treatment of nonalcoholic fatty liver diseases and metabolic disorders (2nd Edition)[J]. J Clin Hepatol, 2018, 34(10): 2103-2108. DOI: 10.3969/j.issn.1001-5256.2018.10.010.

    中华医学会内分泌学分会. 非酒精性脂肪性肝病与相关代谢紊乱诊疗共识(第二版)[J]. 临床肝胆病杂志, 2018, 34(10): 2103-2108. DOI: 10.3969/j.issn.1001-5256.2018.10.010.
    [21] LIU HW, YE H. Research progress on the relationship between sleep, circadian rhythm, intestinal flora and non-alcoholic fatty liver disease[J]. Mod Pract Med, 2019, 31(4): 565-568. DOI: 10.3969/j.issn.1671-0800.2019.04.072.

    柳惠未, 叶桦. 睡眠、昼夜节律及肠道菌群与非酒精性脂肪性肝病关系的研究进展[J]. 现代实用医学, 2019, 31(4): 565-568. DOI: 10.3969/j.issn.1671-0800.2019.04.072.
    [22] YU J, KENNETH E, JAMES Y, et al. From circadian clocks to non-alcoholic fatty liver disease[J]. Expert Rev Gastroenterol Hepatol, 2019, 13(11): 1107-1112. DOI: 10.1080/17474124.2019.1684899.
    [23] SHI DM, CHEN J, WANG JF, et al. Circadian clock genes in the metabolism of non-alcoholic fatty liver disease[J]. Front Physiol, 2019, 10: 423. DOI: 10.3389/fphys.2019.00423.
    [24] TAO YT, FAN JG. Psychological stress in nonalcoholic fatty liver diseases[J]. J Prac Hepatol, 2016, 19(6): 753-756. DOI: 10.3969/j.issn.1672-5069.2016.06.036.

    陶叶婷, 范建高. 心理应激与非酒精性脂肪性肝病[J]. 实用肝脏病杂志, 2016, 19(6): 753-756. DOI: 10.3969/j.issn.1672-5069.2016.06.036.
    [25] WEN YF. Relationship between social mental factors and non-alcoholic fatty liver disease: A case-control study[J]. Chin J Heal Paychol, 2018, 26(4): 565-568. DOI: 10.13342/j.cnki.cjhp.2018.04.023.

    温贻芳. 社会心理因素与非酒精性脂肪肝的关系[J]. 中国健康心理学杂志, 2018, 26(4): 565-568. DOI: 10.13342/j.cnki.cjhp.2018.04.023.
    [26] SUN C, FAN JG. Interpretation of Chinese and foreign non-alcoholic fatty liver disease diagnosis and treatment guidelines[J]. Chin J Pract Intern Med, 2019, 39(3): 235-238. DOI: 10.19538/j.nk2019030108.

    孙超, 范建高. 中外非酒精性脂肪性肝病诊疗指南解读[J]. 中国实用内科杂志, 2019, 39(3): 235-238. DOI: 10.19538/j.nk2019030108.
    [27] LI Y, LIU L, WANG B, et al. Metformin in non-alcoholic fatty liver disease: A systematic review and meta-analysis[J]. Biomed Rep, 2013, 1(1): 57-64. DOI: 10.3892/br.2012.18.
    [28] GINOVANNI M, ROBERTO G, MAURIZIO C, et al. A meta-analysis of randomized trials for the treatment of nonalcoholic fatty liver disease[J]. Hepatology, 2010, 52(1): 79-104. DOI: 10.1002/hep.23623.
    [29] AMIR A, NILOUFAR H, MAEDEH P, et al. Treatment options for nonalcoholic fatty liver disease: A double-blinded randomized placebo-controlled trial[J]. Eur J Gastroenterol Hepatol, 2019, 31(5): 613-617. DOI: 10.1097/MEG.0000000000001369.
    [30] GURUPRASAD PA, JAMES AT, PHILIP VK, et al. Randomized, placebo-controlled trial of pioglitazone in nondiabetic subjects with nonalcoholic steatohepatitis[J]. Gastroenterology, 2008, 135(4): 1176-1184. DOI: 10.1053/j.gastro.2008.06.047.
    [31] FRANCESCO V, ROBERTO C. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis[J]. N Engl J Med, 2010, 363(12): 1185-1186. DOI: 10.1056/NEJMc1006581.
    [32] CHRISTOPHER DW, JOEL S, MICHAEL IA, 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[J]. Gastroenterology, 2011, 140(1): 124-131. DOI: 10.1053/j.gastro.2010.09.038.
    [33] WISE J. Pioglitazone seems safe and effective for patients with fatty liver disease and diabetes[J]. BMJ, 2016, 353: i3435. DOI: 10.1136/bmj.i3435.
    [34] YUICHIRO E, YOCHIRO K, HIDEYUKI H, et al. Pilot study of liraglutide effects in non-alcoholic steatohepatitis and non-alcoholic fatty liver disease with glucose intolerance in Japanese patients (LEAN-J)[J]. Hepatol Res, 2015, 45(3): 269-278. DOI: 10.1111/hepr.12351.
    [35] MATTHEW JA, PIERS G, GURUPASAD PA, et al. Liraglutide safety and efficacy in patients with non-alcoholic steatohepatitis (LEAN): A multicentre, double-blind, randomised, placebo-controlled phase 2 study[J]. Lancet, 2016, 387(10019): 679-690. DOI: 10.1016/S0140-6736(15)00803-X.
    [36] WANG YH, GAO Y. Research progress in diagnosis and treatment of non-alcoholic fatty liver disease combinated with type 2 diabetes mellitus[J]. J Jilin Univ(Med Edit), 2020, 46(6): 1324-1331. DOI: 10.13481/j.1671-587x.20200634.

    王雨涵, 高影. 非酒精性脂肪性肝病并发2型糖尿病诊断和治疗的研究进展[J]. 吉林大学学报(医学版), 2020, 46(6): 1324-1331. DOI: 10.13481/j.1671-587x.20200634.
    [37] ANDREAS V, CHRISTINA A, DIMITRA RB, et al. Systematic review with meta-analysis: The effect of vitamin E supplementation in adult patients with non-alcoholic fatty liver disease[J]. J Gastroenterol Hepatol, 2021, 36(2): 311-319. DOI: 10.1111/jgh.15221.
    [38] ERIN LA, FREDERICK AS, MARTA SM, et al. Vitamin E and all-cause mortality: A meta-analysis[J]. Curr Aging Sci, 2011, 4(2): 158-170. DOI: 10.2174/1874609811104020158.
    [39] ERIC AK, IAN MT, CATHERINE MT, et al. Vitamin E and the risk of prostate cancer: The Selenium and Vitamin E Cancer Prevention Trial (SELECT)[J]. JAMA, 2011, 306(14): 1549-1556. DOI: 10.1001/jama.2011.1437.
    [40] CHELSEA SP, TAKARA LS. Effect of weight loss medications on hepatic steatosis and steatohepatitis: A systematic review[J]. Front Endocrinol(Lausanne), 2020, 11(2): 70. DOI: 10.3389/fendo.2020.00070.
    [41] SCRAGG J, AVERY L, CASSIDY S, et al. Feasibility of a very low calorie diet to achieve a sustainable 10% weight loss in patients with nonalcoholic fatty liver disease[J]. Clin Transl Gastroenterol, 2020, 11(9): e00231. DOI: 10.14309/ctg.0000000000000231.
    [42] AWADHESH KS, RITU S. Pharmacotherapy in obesity: A systematic review and meta-analysis of randomized controlled trials of anti-obesity drugs[J]. Expert Rev Clin Pharmacol, 2020, 13(1): 53-64. DOI: 10.1080/17512433.2020.1698291.
    [43] MARTINA C, RADOSLAVA R, MICHAELA K, et al. Simvastatin does not affect nitric oxide generation increased by sesame oil in obese zucker rats[J]. Oxid Med Cell Longev, 2018, 2018: 5413423. DOI: 10.1155/2018/5413423.
    [44] YUICHIRO Y, SHINO T, MAMORU Y, et al. Atorvastatin reduces cardiac and adipose tissue inflammation in rats with metabolic syndrome[J]. Int J Cardiol, 2017, 240: 332-338. DOI: 10.1016/j.ijcard.2017.04.103.
    [45] LIU L, HAN T, ZHOU LX. Application of statins in prevention and treatment of liver diseases[J]. J Clin Hepatol, 2017, 33(5): 985-989. DOI:10.3969/j. issn.1001-5256.2017.05.041.

    刘路, 韩涛, 周冷潇. 他汀类药物在肝病防治中的应用[J]. 临床肝胆病杂志, 2017, 33(5): 985-989. DOI:10.3969/j. issn.1001-5256.2017.05.041.
    [46] ZHONG Y, SU ST. Treatment of patients with nonalcoholic fatty liver disease[J]. J Prac Hepatol, 2019, 22(1): 145-148. DOI: 10.3969/j.issn.1672-5069.2019.01.038.

    钟燕, 苏淑婷. 非酒精性脂肪性肝病治疗研究进展[J]. 实用肝脏病杂志, 2019, 22(1): 145-148. DOI: 10.3969/j.issn.1672-5069.2019.01.038.
    [47] YU X, WANG WJ, JIN JY, et al. Linggui Zhugan decoction combined with probiotics in the treatment of nonalcoholic fatty liver disease[J]. J Changchun Univ Chin Med, 2019, 35(5): 891-894. DOI: 10.13463/j.cnki.cczyy.2019.05.022.

    喻晓, 王雯婕, 金嘉悦, 等. 苓桂术甘汤联合益生菌治疗非酒精性脂肪肝[J]. 长春中医药大学学报, 2019, 35(5): 891-894. DOI: 10.13463/j.cnki.cczyy.2019.05.022.
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  • 收稿日期:  2020-11-23
  • 录用日期:  2021-01-11
  • 出版日期:  2021-04-20
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