非肥胖型非酒精性脂肪性肝病的诊治对策

Diagnosis and therapeutic strategies for non-obese type of non-alcoholic fatty liver diseases

非酒精性脂肪性肝病和肥胖有相关的基因,但是也可发生在人体质量指数<25 kg/m^2的非肥胖人群中。这种非肥胖型非酒精性脂肪性肝病多发生在亚洲。在肝穿刺活组织病理学检查中肥胖型和非肥胖型非酒精性脂肪性肝病没有明显的差异。内脏肥胖、高果糖和胆固醇摄入、以及遗传因素如APOC3基因变异等与非肥胖型非酒精性脂肪性肝病密切相关。一般来说,非酒精性脂肪性肝炎病死率增加,主要是心血管病因,与其他代谢因素无关。虽然关于非肥胖型非酒精性脂肪性肝病病死率影响的数据并不完整且有限,但诊断、管理、治疗可能很重要。改变生活方式以减少内脏肥胖,包括饮食变化和体力活动,仍然是非肥胖型非酒精性脂肪性肝病患者主要治疗方案。

Non-alcoholic fatty liver disease and obesity have interconnected genes,but it can also occur in non-obese population with body mass index<25 kg/m^2.Non-obese type of non-alcoholic fatty liver disease mostly occurs in Asia.There is no significant difference between obese and non-obese type of non-alcoholic fatty liver in histological examination of liver biopsies.Visceral obesity,high fructose and cholesterol intake,and genetic factors such as APOC3 gene mutation are closely related to non-obese type of non-alcoholic fatty liver.Generally speaking,non-alcoholic steatohepatitis has an increased mortality rate,mainly due to cardiovascular causes,and has no link with other metabolic factors.Although data on the impact of mortality from non-obese type of non-alcoholic fatty liver disease are incomplete and limited,however diagnosis,management,and treatment may be important.Lifestyle changes to reduce visceral obesity,including dietary changes and physical activity,remain the main treatment options for patients with non-obese type of non-alcoholic fatty liver disease.