非酒精性脂肪性肝病相关肝外疾病的研究进展

朱蕗颖; 李雨晨; 邓利华; 王晶桐

doi:10.3969/j.issn.1001-5256.2021.09.043

非酒精性脂肪性肝病相关肝外疾病的研究进展

DOI: 10.3969/j.issn.1001-5256.2021.09.043

北京大学第二临床医学院，北京大学人民医院老年科，北京 100044

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：朱蕗颖负责课题设计, 查阅文献, 撰写论文；李雨晨、邓利华参与文献审核、修改论文；王晶桐负责拟定写作思路, 指导撰写文章并最后定稿。

详细信息

通信作者:
王晶桐，jingtongw@aliyun.com

中图分类号: R575.5
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出版历程
- 收稿日期: 2021-01-19
- 录用日期: 2021-02-18
- 出版日期: 2021-09-20

Research advances in extrahepatic diseases associated with nonalcoholic fatty liver disease

Peking University People's Hospital & The Second Clinical Medical College of Peking University, Beijing 100044, China

摘要

摘要: 非酒精性脂肪性肝病(NAFLD)是全球慢病肝病的主要病因，涵盖了从脂肪变性到炎症和纤维化以至发生肝硬化的一系列病理表现。NAFLD与肝外疾病相关，包括代谢综合征、心血管疾病、慢性肾脏疾病、内分泌疾病、阻塞性睡眠呼吸暂停低通气综合征、银屑病、骨骼肌肉改变等。NAFLD的主要死因包括心血管疾病、恶性肿瘤及肝脏相关并发症，提示临床医生应重视NAFLD相关肝外疾病表现。对NAFLD相关肝外疾病研究进展进行综述，旨在为临床评估及治疗提供思路。
- 非酒精性脂肪性肝病 /
- 代谢综合征X /
- 心血管疾病 /
- 内分泌系统疾病 /
- 肾疾病 /
- 皮肤疾病
Abstract: Nonalcoholic fatty liver disease (NAFLD) is a major cause of chronic liver diseases worldwide and covers a series of pathological manifestations from hepatic steatosis to inflammation, fibrosis, and even liver cirrhosis. NAFLD is associated with a wide range of extrahepatic diseases, including metabolic syndrome, cardiovascular disease, chronic kidney disease, endocrine diseases, obstructive sleep apnea-hypopnea syndrome, psoriasis, and skeleton-muscle diseases. The major causes of death in patients with NAFLD include cardiovascular disease, malignancies, and liver-related complications, suggesting that extrahepatic diseases associated with NAFLD should be taken seriously by clinicians. This article reviews the research advances in extrahepatic diseases associated with NAFLD, so as to provide ideas for clinical assessment and treatment.
- Non-alcoholic Fatty Liver Disease /
- Metabolic Syndrome X /
- Cardiovascular Diseases /
- Endocrine System Diseases /
- Kidney Diseases /
- Skin Diseases

HTML全文

表 1 NAFLD相关肝外疾病及二者之间的联系

肝外器官	疾病表现	建立的联系
代谢综合征	肥胖、2型糖尿病等	NAFLD与代谢功能障碍密切相关, 国际共识建议更名为MAFLD^[5-8]
心血管疾病	动脉粥样硬化、心脏瓣膜病、心律失常、心功能不全等	NAFLD死亡的主要原因是心血管疾病^[9-11]；NAFLD患者患心脏瓣膜病、心律失常、心脏传导系统缺陷、心功能不全风险显著增加^[12-13]
肝外肿瘤	消化道肿瘤、乳腺癌、前列腺癌、皮肤癌等	肝外肿瘤是NAFLD三大死因之一^[9-10]；NAFLD患者结直肠癌、结直肠腺瘤、食管癌、胃癌、胰腺癌、乳腺癌、皮肤癌、前列腺癌、甲状腺癌、肺癌等的风险显著升高^[14-20]
肾脏	慢性肾脏病	NAFLD患者中慢性肾脏病风险显著增加^[21-22]；肝脏病理学改善与肾功能改善独立相关^[23]
内分泌系统	多囊卵巢综合征、甲状腺功能减退症、生长激素缺乏症	肥胖、胰岛素抵抗是NAFLD与多囊卵巢综合征的共同通路, 部分解释了二者的双向联系^[24-30]；NAFLD患者患甲减的风险显著增加^[31-33]；生长激素缺乏与NAFLD相关, 激素替代治疗后肝功能改善^[34-35]
骨及肌肉系统	骨质疏松、肌少症	男性NAFLD患者患骨质疏松的风险显著增加^[36-38]肌少症与NAFLD呈现双向联系, 相互促进^[39-41]
呼吸系统	OSAHS	OSAHS者患NAFLD风险显著升高^[42-45], 睡眠呼吸暂停-低通气指数是肝纤维化的独立预测因子
皮肤	银屑病	银屑病是NAFLD的独立危险因素^[46-50]
血液	血清铁蛋白升高	铁蛋白与NAFLD的组织学表现相关, 是晚期纤维化的独立预测因子^{[5, 51-53]}
注: MAFLD, 代谢相关脂肪性肝病；OSAHS, 阻塞性睡眠呼吸暂停低通气综合征。

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