中国脂肪性肝病诊疗规范化的专家建议(2019年修订版)

Expert recommendations on standardized diagnosis and treatment for fatty liver disease in China (2019 revised edition)

非酒精性脂肪性肝病(NAFLD)已成为我国最常见的慢性肝病。本建议从以下5个方面对NAFLD的规范化诊断和治疗进行了修订:(1)诊治中心/专病门诊的组织架构及功能;(2)筛查和评估:包括筛查对象、初步评估、病因筛查、非酒精性脂肪性肝炎(NASH)和进展性肝纤维化的无创诊断、肝活组织病理学检查以及代谢紊乱和心血管风险评估等;(3)临床处理:包括生活方式(饮食运动减重)调整,合并糖脂代谢紊乱、高血压等特殊人群的处理以及脂肪性肝炎和肝纤维化的药物选择;(4)特殊人群的管理:儿童、妊娠和哺乳期妇女、合并酒精性肝病、慢性HBV和/或HCV感染以及合并自身免疫现象等;(5)监测与随访。本建议旨在优化NAFLD患者的管理流程,指导临床医生制定更为合理的诊疗决策。

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in China. To provide evidence-based and updated practical recommendations for clinician, this expert recommendations have updated the diagnosis and treatment of NAFLD in five aspects as follows:(1) the framework of NAFLD treatment centre or clinic;(2) screening and evaluation: who should be screened, initial evaluation items, non-invasive assessment of steatohepatitis and advanced fibrosis, when to obtain a liver biopsy in patients with NAFLD, and other metabolic disorders and cardiovascular risk assessment;(3) managements of patient with NAFLD: lifestyle intervention (dietary, exercise and weight loss), drug treating metabolic co-morbidities such as hyperlipidemia, type 2 diabetes mellitus and hypertension, and steatohepatitis and fibrosis;(4) management of special populations with NAFLD: children, pregnant or lactating women, patients co-existence with alcoholic liver disease, chronic HBV and/or HCV infection, and autoimmune disorders;(5) monitoring and follow-up. This consensus aims to modify the optimizing management process and guide physicians make correct and reasonable decisions in the diagnosis and treatment for patients with NAFLD.