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
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。
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。Abstract: Metabolic associated fatty liver disease (MAFLD) is currently one of the most important liver diseases worldwide, and its incidence rate is increasing year by year. This article summarizes the current research status of medical treatment of MAFLD, including lifestyle changes and individualized drug treatment. Lifestyle changes include diet management, exercise intervention, biological clock adjustment, and psychological intervention, and individualized drug treatment includes insulin sensitizer, vitamin E, weight-loss and lipid-lowering drugs, liver-protecting and transaminase-lowering drugs, and traditional Chinese medicine treatment. At the same time, multidisciplinary treatment is the trend of clinical treatment of MAFLD.
-
Key words:
- Metabolic Associated Fatty Liver Disease /
- Life Style /
- Drug Therapy
-
[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.
本文二维码
计量
- 文章访问数: 963
- HTML全文浏览量: 161
- PDF下载量: 116
- 被引次数: 0