非酒精性脂肪性肝病诊疗指南

©1994-2010ChinaAcademicJournalElectronicPublishingHouse.Allrightsreserved.(20101):2010-01-08DOI:10.3760/cma.j.jssn.1674-5809.2010.01.000:,200092,E-mail:[e-mail]57515A1001-5256(2010)02-0120-05(NAFLD)(IR),(ALD),,(NAFL)(NASH)[1,2]NAFLD21,[3]NAFLD,,[49],,2006[10]35[11],,11-1-2-3,,NAFLD,,NAFLD,,,,NAFLD,1NAFLD,NAFLD20%33%,NASH10%20%2%3%[1,2,12]SFL60%90%NASH20%25%2%8%,2NAFLD28%55%27%92%[1,2,12,13],20NAFLD,NAFLD15%[3]NAFLD:,IR(2)[3,12,13](HCV),[3,12,14],(bodymassindex,BMI)()NAFLD[3,12,13]NAFLD,BMI[3,12,13]3HCV(hepatitisBvirus,HBV)IR;NAFLDHBVDNAHBV[3,4,16]2NAFLD()NAFL,(1020)(016%3%),NASH(1015)15%25%[1,2]50()2(ALT)(AST)ALT1NASH021ChinJCliniHepatol,April2010,Vol126,No12©1994-2010ChinaAcademicJournalElectronicPublishingHouse.Allrightsreserved.[1,2,9,17]NAFLD,NASHNAFL[1,2],NASH,[1,2,13,17]IR,NAFLNASH;/,NAFL[13,16],,NAFL,3[1,2,9,13,14],NAFLD[ALT-(GGT)],[1,2,9]NAFLNASH,[1,2,9]NAFLD(NAFL),NAFLDBMI[3,13,18,19]NAFLD,(615)2[2,3,9,13,18,19]3311131111NAFLD3[3,5,9,10]:(1)140g/(70g/);(2);(3),NAFLD:(1)[4];()(2)ALT()ASTGGT[4,5,9]IR,NAFLD[4,5,9]31112NAFLD3,[4,5,9,20],NASH()[21]NAFLDNASH,NAFLD(NAFLDactivityscore,NAS)[4,20]NAS(08):(1):0(5%);1(5%33%);2(34%66%);3(66%);(2)(20):0,;1(2);2(24);3(4);(3):0,;1,;2,NAS,NAS3NASH,NAS4NASH,NASH[20]33%NAFL,[10](04):0:;1a:3;1b:3;1c:;2:3;3:;4:,NASH()NAFLD,[4,20]311133[4]:(1)(),;(2);(3)CT,/CT110,/CT110017,017015,015[10]311142005,53[4,22]:(1):90cm(),80cm(),()BMI25kg/m2;(2)(triglyc2erides,TG):TG117mmol/L,TG;(3)(high-den2sitylipoproteincholesterol,HDL-C):HDL-C1103mmol/L(),1129mmol/L();(4):130/85mmHg(1mmHg=01133kPa);(5)(fastingplasmaglucose,FPG):FPG516mmol/L2312231211NAFLD1212010262©1994-2010ChinaAcademicJournalElectronicPublishingHouse.Allrightsreserved.(ALD);()IR(Mauriac)[4,10,16]31212()GGTNAFLD,ALD-1;,[410]31213HBV3HCV,NAFLD[1416]HBsAg,HBVDNA104/ml,NAFLD[4,15,16]31214(140g/,70g/)(280g/,140g/),,[4,16],(),ALDNAFLD[16]313331311(2,),,[410,13,23,24]31312(),,NAFLD[410,17,23,24],:(1)();(2);(3),ALTASTGGT;(4)HBsAg(HBVDNA)-HCV(HCVRNA);(5)TGHDL-C-;(6)FPG,FPG516mmol/L75g(o2ralglucosetolerancetest,OGTT)31313NAFLD,[410,17,23,24]:(1)FPGIR(homeostaticmodelas2sessment,HOMA-IR),OGTT;(2)C-;(3),-;(4);(5),,CT;(6);(7)NAFLNASHNAFLD,NAFLD31314:(1);(2);(3);(4)();(5)[4,9,17,23,24],31315IRIR;TG;XCT;CT;NAFLNASH,[410,17,23,24]4NAFLDNAFL,NAFLDIR,,;NASH,221ChinJCliniHepatol,April2010,Vol126,No12©1994-2010ChinaAcademicJournalElectronicPublishingHouse.Allrightsreserved.[410,17,2325]4411,,(),,20924184KJ(5001000);,,;,4,150min[410,17,23,2628]NAFLD[4,9](-1,-2)412,NAFLD(612)5%,[410,17,23,27](-1,-2)-,[410,17,23,24,27](-1)NAFLD(-1),[4,9,10]413IR,,()(3),NAFLD(),[410,17,2324,29]()NAFLD,[410,17,23,24](,-1,-2,-3)414()NAFLDNASH,-,,,,[10]415NAFLD[410,17,23,24],NAFLD/NASH,[10,16,24]():(1)NASH;(2)(),2NAFLD;(3),;(4),()ES-12(-1,-2,-3),612[10]()416,(III)NASHNAFLD[910,17,23,24](-2),,NAFLD[9,10,17,23,24]55511,,[9,10]()512,;[4,9,10,17,23,24]()513NAFLD,[6,9](),(-)[9,10,13,25,29]()():();();();():();();(3212010262©1994-2010ChinaAcademicJournalElectronicPublishingHouse.Allrightsreserved.);();();();();();();();();();();();()[][1]FarrellGC,LarterCZ.Nonalcoholicfattyliverdisease:fromsteato2sistocirrhosis[J].Hepatology,2006,43(2Suppl1)S99-S112.[2]deAlwisNM,DayCP.Non-alcoholicfattyliverdisease:themistgraduallyclears[J].JHepatol,2008,48(Suppl1)S104-S112.[3]FanJG,FarrellGC.Epidemiologyofnon-alcoholicfattyliverdis2easeinChina[J].JHepatol,2009,50(1)204-210.[4]FarrellGC,ChitturiS,LauGK,etal.Guidelinesfortheassessmentandmanagementofnon-alcoholicfattyliverdiseaseintheAsia-Pacificregion:executivesummary[J].JGastroenterolHepatol,2007,22(6)775-777.[5]AmericanGastroenterologicalAssociation.AmericanGastroenterolog2icalAssociationmedicalpositionstatement:nonalcoholicfattyliverdisease[J].Gastroenterology,2002,123(5)1702-1704.[6]GrattaglianoI,PortincasaP,PalmieriVO,etal.Managingnonalco2holicfattyliverdisease:recommendationsforfamilyphysicians[J].CanFamPhysician,2007,53(5)857-863.[7]EckelRH,GrundySM,ZimmetPZ.Themetabolicsyndrome[J].Lancet,2005,365(9468)1415-1428.[8]CohenDE,AnaniaFA,ChalasaniN,etal.Anassessmentofstatinsafetybyhepatologists[J].AmJCardiol,2006,97(8A)77C-81C.[9]VuppalanchiR,ChalasaniN.Nonalcoholicfattyliverdiseaseandnonalcoholicsteatohepatitis:Selectedpracticalissuesintheirevalua2tionandmanagement[J].Hepatology,2009,49(1)306-317.[10]ZengMD,FanJG,LuLG,etal.Guidelinesforthediagnosisandtreatmentofnonalcoholicfattyliverdiseases[J].JDigDis,2008,9(2)108-112.[11]LokAS,McMahonBJ;PracticeGuidelinesCommittee,AmericanAssociationfortheStudyofLiverDiseases(AASLD).Chronichepa2titisB:updateofrecommendations[J].Hepatology,2004,39(3)857-861.[12]AnguloP.GIepidemiology:nonalcoholicfattyliverdisease[J].AlimentPharmacolTher,2007,25(8)883-889.[13]FanJG,SaibaraT,ChitturiS,etal.Whataretheriskfactorsandsettingsofnon-alcoholicfattyliverdiseaseinAsia-Pacific?[J].JGastroenterolHepatol,2007,22(6)794-800.[14]CheungO,SanyalAJ.HepatitisCinfectionandnonalcoholicfattyliv