Tom 14, Nr 1 (2020)
Wybrane problemy kliniczne
Opublikowany online: 2020-03-01
Wyświetlenia strony
2027
Wyświetlenia/pobrania artykułu
1420
Niealkoholowa stłuszczeniowa choroba wątroby (NAFLD) — etiologia, rozpoznanie, leczenie w świetle aktualnej wiedzy
Forum Medycyny Rodzinnej 2020;14(1):1-10.
Streszczenie
Niealkoholowa stłuszczeniowa choroba wątroby (NAFLD) jest jedną z najczęstszych przewlekłych chorób wątroby na świecie i dotyczy około 25% popula cji. Stanowi jedną z najczęstszych przyczyn marskości wątroby i transplantacji wątroby w Stanach Zjednoczonych. Charakteryzuje się nadmiernym gromadzeniem tłuszczów w wątrobie u osób nienadużywających alkoholu, któremu towar zyszy insulinooporność. Obejmuje dwie jed - nostki chorobowe: niealkoholowe stłuszczenie wątroby i niealkoh olowe stłuszczeniowe zapalenie wątroby. Późno rozpoznana i nieleczona może prowadzić do rozwoju marskości wątroby i raka wątroby oraz powikłań sercowo-naczyniowych. Głównymi czynnikami ryzyka NAFLD są: otyłość, zabur zenia lipidowe, cukrzyca, nadciśnienie tętnicze. W rozpoznaniu wykorzystuje się biopsję wątroby, badanie ultrasonograficzne, rezonans magnetyczny, elastografię wątroby oraz skale punktowe — NAFLD fibrosis score (NFS) i FIB-4 Index. Przebieg kliniczny NAFLD jest zazwyczaj bezobjawowy. Leczenie polega na zmianie stylu życia, interwencji dietetycznej, redukcji masy ciała, regularnej aktywności fizycznej oraz leczeniu poszczególnych czynników ryzyka. W niektórych przypadkach wskazane jest zastosowanie witaminy E i pioglitazonu w leczeniu NAFLD. L eczenie celowane NAFLD jest obecnie na etapie badań klinicznych. W artykule przedstawiono etiologię, metody diagnostyki i leczenia NAFLD w codziennej praktyce klinicznej.
Słowa kluczowe: NAFLDNASHmarskość wątrobyotyłośćcukrzyca
Referencje
- Sayiner M, Koenig A, Henry L, et al. Epidemiology of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis in the United States and the Rest of the World. Clin Liver Dis. 2016; 20(2): 205–214.
- Leite NC, Salles GF, Araujo ALE, et al. Prevalence and associated factors of non-alcoholic fatty liver disease in patients with type-2 diabetes mellitus. Liver Int. 2009; 29(1): 113–119.
- Younossi ZM, Koenig AB, Abdelatif D, et al. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016; 64(1): 73–84.
- European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the Management of Non-Alcoholic Fatty Liver Disease. Obes Facts. 2016; 9(2): 65–90.
- Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018; 67(1): 328–357.
- Ahmed A, Wong RJ, Harrison SA. Nonalcoholic Fatty Liver Disease Review: Diagnosis, Treatment, and Outcomes. Clin Gastroenterol Hepatol. 2015; 13(12): 2062–2070.
- Yeh MM, Brunt EM. Pathological features of fatty liver disease. Gastroenterology. 2014; 147: 754–764.
- Losekann A, Weston AC, de Mattos AA, et al. Non-Alcoholic Steatohepatitis (NASH): Risk Factors in Morbidly Obese Patients. Int J Mol Sci. 2015; 16(10): 25552–25559.
- Kaswala DH, Lai M, Afdhal NH. Fibrosis Assessment in Nonalcoholic Fatty Liver Disease (NAFLD) in 2016. Dig Dis Sci. 2016; 61(5): 1356–1364.
- Kleiner DE, Brunt EM. Nonalcoholic fatty liver disease: pathologic patterns and biopsy evaluation in clinical research. Semin Liver Dis. 2012; 32(1): 3–13.
- Loomis AK, Kabadi S, Preiss D, et al. Body Mass Index and Risk of Nonalcoholic Fatty Liver Disease: Two Electronic Health Record Prospective Studies. J Clin Endocrinol Metab. 2016; 101(3): 945–952.
- Miyake T, Kumagi T, Furukawa S, et al. Non-alcoholic fatty liver disease: factors associated with its presence and onset. J Gastroenterol Hepatol. 2013; 28 Suppl 4: 71–78.
- Margariti E, Deutsch M, Manolakopoulos S, et al. Non-alcoholic fatty liver disease may develop in individuals with normal body mass index. Ann Gastroenterol. 2012; 25(1): 45–51.
- Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018; 67(1): 328–357.
- Angulo P, Kleiner DE, Dam-Larsen S, et al. Liver Fibrosis, but No Other Histologic Features, Is Associated With Long-term Outcomes of Patients With Nonalcoholic Fatty Liver Disease. Gastroenterology. 2015; 149(2): 389–97.e10.
- Chen J, Zhu Y, Zheng Qi, et al. Serum cytokeratin-18 in the diagnosis of non-alcoholic steatohepatitis: A meta-analysis. Hepatol Res. 2014; 44(8): 854–862.
- Park CC, Nguyen P, Hernandez C, et al. Magnetic Resonance Elastography vs Transient Elastography in Detection of Fibrosis and Noninvasive Measurement of Steatosis in Patients With Biopsy-Proven Nonalcoholic Fatty Liver Disease. Gastroenterology. 2017; 152(3): 598–607.e2.
- Friedrich-Rust M, Rosenberg W, Parkes J, et al. Comparison of ELF, FibroTest and FibroScan for the non-invasive assessment of liver fibrosis. BMC Gastroenterol. 2010; 10: 103.
- Angulo P, Hui JM, Marchesini G, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007; 45(4): 846–854.
- Ekstedt M, Hagström H, Nasr P, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology. 2015; 61(5): 1547–1554.
- Kleiner DE, Brunt EM, Van Natta M, et al. Nonalcoholic Steatohepatitis Clinical Research Network. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005; 41(6): 1313–1321.
- Bedossa P, Poitou C, Veyrie N, et al. Histopathological algorithm and scoring system for evaluation of liver lesions in morbidly obese patients. Hepatology. 2012; 56(5): 1751–1759.
- Harrison S, Praca E, Brozek J, et al. A new non-invasive diagnostic score to monitor change in disease activity and predict fibrosis evolution in patients with NASH. Journal of Hepatology. 2017; 66(1): S110.
- Shah AG, Lydecker A, Murray K, et al. Nash Clinical Research Network. Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2009; 7(10): 1104–1112.
- Fierbinteanu-Braticevici C, Plesca DA, Tribus L, et al. The role of ¹³C-methacetin breath test for the non-invasive evaluation of nonalcoholic fatty liver disease. J Gastrointestin Liver Dis. 2013; 22(2): 149–156.
- Helmke SM, Marr JD, Cookson MW, et al. Diagnosing of NASH and assessing NASH disease severity by a global measure of liver function, the HepQuant! (HQ)-SHUNT test Hepatology. 2016; 63: 584A.
- Said A, Ghufran A. Epidemic of non-alcoholic fatty liver disease and hepatocellular carcinoma. World J Clin Oncol. 2017; 8(6): 429–436.
- Sung KC, Ryu S, Lee JY, et al. Effect of exercise on the development of new fatty liver and the resolution of existing fatty liver. J Hepatol. 2016; 65(4): 791–797.
- Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, et al. Weight Loss Through Lifestyle Modification Significantly Reduces Features of Nonalcoholic Steatohepatitis. Gastroenterology. 2015; 149(2): 367–78.e5; quiz e14.
- Haufe S, Engeli S, Kast P, et al. Randomized comparison of reduced fat and reduced carbohydrate hypocaloric diets on intrahepatic fat in overweight and obese human subjects. Hepatology. 2011; 53(5): 1504–1514.
- Konerman MA, Jones JC, Harrison SA. Pharmacotherapy for NASH: Current and emerging. J Hepatol. 2018; 68(2): 362–375.
- Lindor KD, Kowdley KV, Heathcote EJ, et al. Ursodeoxycholic acid for treatment of nonalcoholic steatohepatitis: results of a randomized trial. Hepatology. 2004; 39(3): 770–778.
- Ratziu V, de Ledinghen V, Oberti F, et al. FRESGUN. A randomized controlled trial of high-dose ursodesoxycholic acid for nonalcoholic steatohepatitis. J Hepatol. 2011; 54(5): 1011–1019.
- Makri E, Cholongitas E, Tziomalos K. Emerging role of obeticholic acid in the management of nonalcoholic fatty liver disease. World J Gastroenterol. 2016; 22(41): 9039–9043.
- Mathurin P, Hollebecque A, Arnalsteen L, et al. Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease. Gastroenterology. 2009; 137(2): 532–540.
- Lassailly G, Caiazzo R, Buob D, et al. Bariatric Surgery Reduces Features of Nonalcoholic Steatohepatitis in Morbidly Obese Patients. Gastroenterology. 2015; 149(2): 379–88; quiz e15.
- Sasaki A, Nitta H, Otsuka K, et al. Bariatric surgery and non-alcoholic Fatty liver disease: current and potential future treatments. Front Endocrinol (Lausanne). 2014; 5: 164.
- Sanyal AJ, Chalasani N, Kowdley KV, et al. NASH CRN. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. N Engl J Med. 2010; 362(18): 1675–1685.
- Klein EA, Thompson Jr I M, Tangen CM. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA . 2011; 306: 1549–1556.
- Miller ER, Pastor-Barriuso R, Dalal D, et al. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med. 2005; 142(1): 37–46.
- Boettcher E, Csako G, Pucino F, et al. Meta-analysis: pioglitazone improves liver histology and fibrosis in patients with non-alcoholic steatohepatitis. Aliment Pharmacol Ther. 2012; 35(1): 66–75.
- Hannah WN, Torres DM, Harrison SA. Nonalcoholic Steatohepatitis and Endpoints in Clinical Trials. Gastroenterol Hepatol (N Y). 2016; 12(12): 756–763.
