資源描述：
《非酒精性脂肪性肝病的診斷》由會(huì)員上傳分享，免費(fèi)在線閱讀，更多相關(guān)內(nèi)容在教育資源-天天文庫。
1、非酒精性脂肪性肝病的診斷與治療川北醫(yī)學(xué)院附屬醫(yī)院消化內(nèi)科概念Fattyliver(hepaticsteatosis)Excessiveaccumulationoflipidinhepatocytes,themostcommonresponseofthelivertoinjury.脂肪肝(定義)疾病譜病因單純性脂肪肝脂肪性肝硬化脂肪性肝炎酒精性肝病NAFLD原發(fā)性繼發(fā)性流行病學(xué)*Definingnonalcoholicfattyliverdisease:implicationsforepidemi
2、ologicstudies.Gastroenterology.2003Jan;124(1):248-50.Review.Indeed,thepreponderanceofasymptomaticindividualswithfattyliverhastemptedsometoconcludethatfattyliveralonemaybeavariantofnormalcy,ratherthanatruediseaseHowever,applyingsimilarlogicwouldforceo
3、netoconcludethatasymptomaticindividualswithabloodpressureof180/100mmHg,afastingbloodsugarof180mg/dL,orlowdensitylipoproteinsof200mg/dL,whileabnormal,donothaveadiseasestate“stillwatersrundeep.”隨著社會(huì)經(jīng)濟(jì)發(fā)展，非酒精性脂肪性肝?。∟AFLD）患病率迅速增高，現(xiàn)已成為危害人類健康的三大肝病之一NAFLD與失代
4、償期肝硬化、肝功能衰竭、原發(fā)性肝癌的發(fā)生密切相關(guān)在美國，NAFLD是轉(zhuǎn)氨酶長期增高及隱源性肝硬化最常見的原因**ClarkJM,DiehlAM.Nonalcoholicfattyliverdisease:anunderrecognizedcauseofcryptogeniccirrhosis.JAMA,2003，289:3000-3004研究表明，肥胖是NAFLD的獨(dú)立危險(xiǎn)因素肥胖者中NAFLD的發(fā)生率約為50%，其中，單純性脂肪肝30%，非酒精性脂肪性肝炎（NASH）24-30.5%，肝纖維化
5、28%，肝硬化1.5-8%這種與肥胖相關(guān)的NAFLD已成為全球普遍關(guān)注的醫(yī)學(xué)問題和社會(huì)問題NAFLD可能為歐美等發(fā)達(dá)國家第一大肝病，成人脂肪肝患病率高達(dá)20％～30％，其中10％或2％～3％的成人為NASH，約1/3NASH病人并發(fā)進(jìn)展性肝纖維化和肝硬化。肥胖人群的發(fā)生率更高兒童NAFLD/NASH發(fā)病率亦不斷增高，NASH青少年肝纖維化發(fā)生率70%，并有肝硬化發(fā)生病理Twopatternsofhepaticsteatosis:(1)microvesicularsteatosis:thecyto
6、plasmisreplacedbybubblesoffatthatdonotdisplacethenucleus(2)macrovesicularsteatosis:thecytoplasmisreplacedbyalargebubbleoffatthatdisplacesthenucleustotheedgeofthecell*FromSanyalAJ.Nonalcoholicsteatohepatitis.ClinicalPerspectivesinGastroenterology.2000
7、;129Steatohepatitisisshownhere.Thehistologicfindingsshownincludemacrovesicularsteatosis,cytologicballooning,Mallorybodies,andscatteredlobularinflammationMallorybodyisshownwithinaballoonedhepatocytePericellularfibrosisisshown(Masson'strichromestain).T
8、hecollagenoustissue(showninblue)surroundsindividualhepatocytes,producingachicken-wireappearance.病因發(fā)病機(jī)制發(fā)病機(jī)制Day的二次打擊學(xué)說NAFL初次打擊主要是IR，IR通過促進(jìn)外周脂肪分解和高胰島素血癥引起肝細(xì)胞脂肪變性，并啟動(dòng)細(xì)胞適應(yīng)程序，而脂肪變性的肝細(xì)胞活力相對(duì)不足并為氧應(yīng)激提供了足夠的反應(yīng)基質(zhì)，結(jié)果脂肪變性的肝細(xì)胞對(duì)內(nèi)、外源性損害因子的敏感性增強(qiáng)*DayCP,JamesOF.Steatohep
