重视非酒精性脂肪性肝病自然史的研究

Research on the natural history of non-alcoholic fatty liver disease should be taken seriously

非酒精性脂肪性肝病（NAFLD）是一种多系统性疾病，与代谢综合征和2型糖尿病互为因果。心血管疾病和恶性肿瘤相关死亡是非酒精性脂肪肝和非酒精性脂肪性肝炎（NASH）患者共同的不良结局，肝病病死率显著增加主要见于NASH患者。NASH与肝细胞癌之间存在因果关系，NASH相关肝细胞癌一半左右发生于没有肝硬化的患者。当前亟需加强我国NAFLD患者自然史的队列研究，从而为制定卫生策略和防治对策提供依据。现主要从临床流行病学角度阐述NAFLD与糖尿病、心血管疾病以及肝硬化和肝细胞癌的重要关联，以提醒大家对NAFLD自然史的重视。

Nonalcoholic fatty liver disease （NAFLD） is a multi-system disease, and metabolic syndrome, type 2 diabetes, and NAFLD interact as both cause and effect. Deaths caused by cardiovascular diseases and malignant tumors are the adverse outcome of patients with NAFLD and nonalcoholic steatohepatitis （NASH）, and increased deaths caused by liver disease is mainly seen in NASH patients. There is a causal relationship between NASH and hepatocellular carcinoma, and almost 50% of patients with NASH-associated hepatocellular carcinoma do not have liver cirrhosis. At present, cohort studies on the natural history of NAFLD in China should be enhanced in order to provide a basis for the development of health strategies and prevention and treatment measures. This editorial elaborates on the association of NAFLD with diabetes, cardiovascular disease, liver cirrhosis, and hepatocellular carcinoma from the perspective of clinical epidemiology, in order to emphasize the importance of the natural history of NAFLD.