瘦型非酒精性脂肪性肝病的研究进展

Research advances in nonalcoholic fatty liver disease in lean individuals

非酒精性脂肪性肝病(NAFLD)在全球的发病率不断上升,在美国等发达国家是导致慢性肝病的主要原因,将来也可能会是中国最常见的慢性肝病。NAFLD多发生于肥胖人群,然而瘦型NAFLD在全世界也很常见。总结了最近瘦型NAFLD相关的研究,并阐述该病发病机制主要包括以下途径:单核苷酸多态性改变是导致瘦人发生NAFLD的易患因素之一;由于肠道菌群改变以及骨骼肌萎缩使机体易发生多种代谢异常,如高血脂、高血尿酸、胰岛素抵抗以及铁代谢异常,代谢异常亦可促进NAFLD的发生;此外,不健康的饮食习惯以及生活方式,易使脂肪在体内蓄积,增加肝脏负荷。这些因素的共同作用最终导致了NAFLD的发生。然而,确切的发病机制仍需进一步研究。

The incidence rate of nonalcoholic fatty liver disease(NAFLD)is continuously increasing in the world,and NAFLD is a major cause of chronic liver disease in developed countries such as the United States and may become the most common chronic liver disease in China in the future.NAFLD is often observed in the obese population;however,it is also commonly seen in lean individuals.This article summarizes the latest studies on lean NAFLD and elaborates on the following pathogeneses of this disease:the change in single nucleotide polymorphism is one of the predisposing factors for NAFLD in the lean population;the change of gut microbiota and sarcopenia may induce a variety of metabolic disorders including hyperlipidemia,hyperuricemia,insulin resistance,and iron metabolic disorders,and such metabolic disorders may promote the development of NAFLD;in addition,unhealthy dietary habits and lifestyle may contribute to the accumulation of fat and increase the burden of the liver.The combined effect of these factors eventually lead to the development of NAFLD,but further studies are still needed to clarify the pathogenesis of lean NAFLD.