从非酒精性脂肪性肝病到代谢相关脂肪性肝病:解析肝外疾病关联与诊治策略变化

From non-alcoholic fatty liver disease to metabolic-related fatty liver disease:analysis of extra-hepatic disease associations and changes in diagnostic and treatment strategies

非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)是一种多系统疾患,具有广泛的肝外表现,如心血管疾病、肝外恶性肿瘤、代谢综合征、慢性肾衰、脑血管疾病和认知障碍、多囊卵巢综合征、甲状腺功能减退。NAFLD最常见的死亡原因是心血管疾病、肝外恶性肿瘤和肝脏疾病,与死亡率相关的因素包括年龄、糖耐量受损和肝硬化。代谢相关脂肪性肝病(metabolic-associated fatty liver disease,MAFLD)是NAFLD的新定义,主要被定义为伴有肥胖、糖尿病或综合代谢障碍的肝脂肪沉积。尽管两者诊断标准有所重叠,但患病人群并不完全相同。研究NAFLD/MAFLD与肝外疾病的关联,并进一步阐述从NAFLD到MAFLD相应肝外疾病诊断及治疗演进,对于及时筛查和多学科管理疾病谱具有重大意义。

Non-alcoholic fatty liver disease(NAFLD)is a multisystem disorder with a wide range of extrahepatic manifestations.Its manifestations include cardiovascular diseases,extrahepatic malignancies,metabolic syndrome,chronic kidney failure,cerebrovascular diseases,cognitive impairment,polycystic ovary syndrome and hypothyroidism.The most common causes of death in NAFLD patients are cardiovascular diseases,extrahepatic malignancies,and liver diseases.Factors associated with mortality include age,impaired glucose tolerance,and liver cirrhosis.Metabolic associated fatty liver disease(MAFLD)is a new definition for NAFLD.It is primarily characterized by hepatic fat accumulation in the presence of obesity,diabetes or metabolic dysregulation.Although the two diagnostic criteria overlap,the affected populations are not exactly the same.It is of great significance for timely screening and multidisciplinary management of the disease spectrum by investigating the association between NAFLD/MAFLD and extrahepatic diseases,and further elucidating the evolution of diagnosis and treatment of extrahepatic conditions from NAFLD to MAFLD.