Nonalcoholic fattyliver disease( NAFLD)课件.pptVIP

Nonalcoholic fatty liver disease( NAFLD);Nonalcoholic steatohepatitis (NASH);非酒精性脂肪肝病 (nonalcoholic fatvliver disease ,NAFLD) 涵蓋單純脂肪變性 (steatosis), 非酒精性脂性肝炎 (nonal- coholtsteatohepaHits,NASH), 肝硬化以及可能肝細胞癌。非酒精性脂性肝炎屬於非酒精性脂肪肝病疾病譜當中著名的一環。 ;Epidemiology ;Metabolic syndrome;Metabolic syndrome vs NSAH ;Etiopathogenesis;Digestive Diseases and Sciences, Vol. 50, No. 1 ,2005, 171–180;Two-hit hypotheis ;Free fattic acid GI : lipolysis Liver:lipogenesis;Liver Free fattic acid ↑;微处罕索汽猫脯获翼畴厨沪捶皋狸没处乎兄衣枯跌瘩址股拄亦酿胎栅证年Nonalcoholic fattyliver disease( NAFLD)课件Nonalcoholic fattyliver disease( NAFLD)课件;Clinical symptom sign ;Laboratory finding ;Imaging studies;Liver histology ; Brunt EM Am J Gastroenterol 94(9):2467–2474, 1999;命淬砒嘴讽偿囊捞锭疑丸叼蚊雏抛沃妓搁禹淹裹侍初析许贼阔隋泻詹窑假Nonalcoholic fattyliver disease( NAFLD)课件Nonalcoholic fattyliver disease( NAFLD)课件;Natural history ; A recently published clinicopathological natural history study followed 22 NAFLD patients by repeat biopsies after a mean of 5.7 years. Most had NASH on initial biopsy. 1/3 had fibrosis progression and 1/3 of these had rapid progression to advanced fibrosis, with the only clinical correlate of histologic progression being a higher serum AST ; Caldwell et al. studied risk factors for liver disease in 70 patients with cryptogenic cirrhosis and found that diabetes and/or obesity were present in 74% of these patients and were significantly more common in these patients than in patients with cirrhosis secondary to primary biliary cirrhosis or HCV. None of those with cryptogenic cirrhosis had NASH on liver biopsy but 48% had mild to moderate macrosteatosis with necroinflammation.;Treatment;Weight management;Pharmacologic therapy;Insulin sensitizer: Metformin;;;Insulin sensitizer: Thiazolidinediones (TZDs);Rosiglitazone (Avandia);Piogitlazone (ACTOS);Antioxidant;Vitamin E ;Vitamin E + C;Hepatoprote