非酒精性脂肪性肝病的同质性和异质性

Heterogeneity and homogeneity of nonalcoholic fatty liver disease

非酒精性脂肪性肝病(NAFLD)已经成为世界和我国流行最高的肝脏疾病。NAFLD在发病机制、病理学、临床表型等方面具有异质性。在发病机制方面,至少包括代谢/肥胖因素和基因多态性的因素;在病理学方面,成人NAFLD的肝纤维化表现为非典型的纤维化和窦纤维化,而儿童的NAFLD患者的肝纤维化在早期主要表现为汇管区纤维化,部分表现为小叶纤维化;在临床表型方面,NAFLD又可以表现为伴或不伴有糖尿病、伴或不伴有肥胖。这些异质性提示临床诊断、治疗和治疗效果评价的策略与方法不同。

Nonalcoholic fatty liver disease(NAFLD)has become the most prevalent liver disease in China and the world.However,heterogeneity exists in the pathogenesis,pathology,and clinical phenotype of NAFLD.Metabolism/obesity and gene polymorphisms are involved in the pathogenesis of NAFLD.As for pathology,NAFLD in adults manifests as atypical fibrosis and sinus fibrosis,while NAFLD in children manifests as fibrosis in the portal area and lobular fibrosis in early stage.As for clinical phenotype,some patients may have diabetes or obesity.Such heterogeneity suggests that there are different strategies and methods for clinical diagnosis,treatment,and outcome evaluation.