Nonalcoholic steatohepatitis and the metabolic syndrome

被引:183
作者
Neuschwander-Tetri, BA [1 ]
机构
[1] St Louis Univ, Ctr Liver, Dept Internal Med, Div Gastroenterol & Hepatol, St Louis, MO 63110 USA
关键词
fatty liver; cirrhosis; insulin resistance; liver biopsy; alanine aminotransferase;
D O I
10.1097/00000441-200512000-00011
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Relatively recently, the liver has been recognized as a major target of injury in patients with insulin resistance or the metabolic syndrome. Insulin resistance is associated with fat accumulation in the liver, a condition called nonalcoholic fatty liver disease (NAFLD). Excess fat in the liver is not a benign condition. Some patients with NAFLD develop necroinflammatory changes in the liver called nonalcoholic steatohepatitis (NASH) and a fraction of those will develop cirrhosis. About 20% all adults have NAFLD and 2% to 3% of adults have NASH. Approximately 20% of patients with NASH are at risk for developing cirrhosis and subsequently dying from end-stage liver disease. The diagnosis of NASH requires a high index of suspicion, especially in obese patients over the age of 45 years who have diabetes, because these are the patients at greatest risk for developing cirrhosis. Treatment focuses on addressing the underlying insulin resistance with increased exercise and weight reduction.
引用
收藏
页码:326 / 335
页数:10
相关论文
共 93 条
[81]  
Sorbi D, 2000, AM J GASTROENTEROL, V95, P3206
[82]  
Sorbi D, 1999, AM J GASTROENTEROL, V94, P1018
[83]   Silent non-alcoholic fatty liver disease - a clinical-histological study [J].
Sorrentino, P ;
Tarantino, G ;
Conca, P ;
Perrella, A ;
Terracciano, ML ;
Vecchione, R ;
Gargiulo, G ;
Gennarelli, N ;
Lobello, R .
JOURNAL OF HEPATOLOGY, 2004, 41 (05) :751-757
[84]   Hepatic pseudolesion around the falciform ligament: Prevalence on CT examination [J].
Soyer, P ;
Devine, N ;
Somveille, E ;
Rebibo, G ;
Rambert, C ;
Scherrer, A .
ABDOMINAL IMAGING, 1996, 21 (04) :324-328
[85]   Surgery for severe obesity [J].
Steinbrook, R .
NEW ENGLAND JOURNAL OF MEDICINE, 2004, 350 (11) :1075-1079
[86]   Effects of rosiglitazone and metformin on liver fat content, hepatic insulin resistance, insulin clearance, and gene expression in adipose tissue in patients with type 2 diabetes [J].
Tiikkainen, M ;
Häkkinen, AM ;
Korsheninnikova, E ;
Nyman, T ;
Mäkimattila, S ;
Yki-Järvinen, H .
DIABETES, 2004, 53 (08) :2169-2176
[87]   Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. [J].
Tuomilehto, J ;
Lindström, J ;
Eriksson, JG ;
Valle, TT ;
Hamalainen, H ;
Ilanne-Parikka, P ;
Keinanen-Kiukaanniemi, S ;
Laakso, M ;
Louheranta, A ;
Rastas, M ;
Salminen, V ;
Uusitupa, M ;
Aunola, S ;
Cepaitis, Z ;
Moltchanov, V ;
Hakumaki, M ;
Mannelin, M ;
Martikkala, V ;
Sundvall, J .
NEW ENGLAND JOURNAL OF MEDICINE, 2001, 344 (18) :1343-1350
[88]   IS LIVER-BIOPSY USEFUL IN THE EVALUATION OF PATIENTS WITH CHRONICALLY ELEVATED LIVER-ENZYMES [J].
VANNESS, MM ;
DIEHL, AM .
ANNALS OF INTERNAL MEDICINE, 1989, 111 (06) :473-478
[89]   Is weight reduction an effective therapy for nonalcoholic fatty liver? A systematic review [J].
Wang, RT ;
Koretz, RL ;
Yee, HF .
AMERICAN JOURNAL OF MEDICINE, 2003, 115 (07) :554-559
[90]   FATTY LIVER HEPATITIS (STEATOHEPATITIS) AND OBESITY - AN AUTOPSY STUDY WITH ANALYSIS OF RISK-FACTORS [J].
WANLESS, IR ;
LENTZ, JS .
HEPATOLOGY, 1990, 12 (05) :1106-1110