非酒精性脂肪肝的臨床診斷與治療進(jìn)展課件

非酒精性脂肪性肝炎主講人:楊梅Medscapemedscape.compulation()Generacoulston(N-35435.0Employees(N=1581enerapopulaton(N=3175netal,20020minisatMeofficers(N=4009)USGenerapoulationIN=32日Kacamakyeta.2004elderlyWN=134etaL200enera∞圖Omagaiat堿,200234ardH-Cerveraeta,2006-1Medcoeta.2005UnitadSateGenerapopulaton(N-22871nyalocholINtrenzymesGenerapopulation[M=1°6ASTOALTorGGT4.7Clarketal.2003-8UnitedSatesRepwreoftheU.sASTOALTRuhletal200°Deaths.generaPopulatonAutopsy3016PorosisNAweliverdonorsIN=2631Biopsy1%NASHBntetal聲ASHnarukamistethemUS,utAnotapplicableCT,computedtomograph:MS,magnetcMedscapewwmedscape.comNAFLDPrevalenceType2daberersnatentsN=2809695Desch-Diatlenetal2006Garrbmatin-Gewwanetal,2007UnitadStatesPeieystieeuarysyndrome(N-8UntedStatesChanicLvarDnaseRegtryWN=7421US/C39.1IverenzymeaLiangpunsakuetal2005"opulation,Dionsstud斷BanacncsurgerypatentsIN=112)Blcpsy55了NAsH16tboBanatncsurgerypabentsN=14676041.1NASHChileBalancsurgerypatentsN=127Bid≈e0NAsH15arrowsMoiledetal2008/ranceType2dabetes+USpositiveWN=32)Biapsy2004BalanesurgurypatientN=1003.0ForessHsomn。鈥ta,20044Bc720725NACH2.fboeBruntetaP3BiopsyLievenal,2006osananasurgerypaBiopsy96.oNAsH260brosntedstatesBanatnesurgerypabentsIN=16untetar26NASH313fbrossONASH120ngetal2005edStatesBalancsurgerypatent26.0NASH/3.0fibrosisBiopsy440NASH'80cirrhosisModrindstatchepatieUs,ulusound:CI,computedtomographNAnotapplet:ALT,anneamnomanstese:HCv,hepatisCvrus:NASH-CHN,sanaeehslestRiskfactorAuthor(year)ReferencenoAge>50yearsGarcia-Monzonetal.(2000)137Ratziueta/.(2000)Anguloetal.(1999)ObesityWanless可ta.(1990)Ratziueta/.(2000)138Anguloetal.(1999)Type2diabetesWanlesseta/.(1990)Anguloeral.(1999)個(gè)GradesWanlesseta/.(1990)inflammationGarcia-Monzonetal.(2000)137Ratziueta/.(2000)HypertensionWillnereta/.(2001140Dixonetal.(2001)142AST/ALTratic≥1Anguloetal.(1999)Sorbieta/.(1999)144Georgeetal.(1998)DegreeofWanlesseta/.(1990)139steatosis,TfreeGarcia-Monzonetal.(2000137fattyacidsmillnereta/.(2001)Triglycerides>Ratziueta/.(2000)ALT>2>normRatziueta/.(2000)188Dixoneta/.(2001)脂肪肝的基本概念狹義的定義肝內(nèi)甘油三酯儲(chǔ)積>肝臟濕重的5%,光鏡下每單位面積見(jiàn)>30%的肝實(shí)質(zhì)細(xì)胞出現(xiàn)脂變,稱為脂肪性肝病(fattyliverdiseasefld),簡(jiǎn)稱脂肪肝。根據(jù)病情進(jìn)展的疾病譜分為單純性脂肪肝(nonalcoholicfattyliverNAFL)脂肪性肝炎(nonalcoholicsteatohepatitisNASH脂肪性肝硬化正常肝肝硬化FattycirrhosisGa←脂肪肝分類根據(jù)脂肪變性累及范圍彌漫性脂肪肝(急性和慢性)局灶性脂肪肝彌漫性脂肪肝伴正常肝島根據(jù)病因酒精性脂肪肝(alcoholicliverdiseaseAlD)非酒精性脂肪肝(nonalcoholicfattyliverdiseasenafld)NAFLD的病因insulinresistanceglucoseintoleranceDiabetescentralobeseysllpldaemlahypertensionHowever,afterexclusionofahistoryofsignificantalcoholintake,whichisconventionally<20g/dayNAFLD的病因nutritionalcauses:rapidweightlossandtotalparenteralnutritionraremetabolicdisordersanddrug-inducedsteatosis.Commonlyimplicatedagents:glucocorticoidsamiodarone,syntheticoestrogensandhighlyactiveantiretroviraldrugs(haartSteatosisisalsofrequentlyassociatedwithhepatitisC,particularlygenotype3,andendocrinedisorderssuchaspolycysticovarysyndrome(PCOS),hypopituitarismandhypothyroidismPrimayNAFLDConditionsassociatedwithinsulinesisancesyndrometype2diabetes,obesity,hyperlipaemiaSeconda