Title

非酒精性脂肪肝病與非酒精性脂肪肝炎之診斷與流行病學

Translated Titles

Diagnosis and Epidemiology of Non-Alcoholic Fatty Liver Disease and Non-Alcoholic Steatohepatitis

DOI

10.6320/FJM.202205_26(3).0005

Authors

劉俊人(Chun-Jen Liu)

Key Words

非酒精性脂肪肝病 ; 代謝症狀群 ; 慢性病毒性肝炎 ; 肝細胞癌 ; non-alcoholic fatty liver disease ; metabolic syndrome ; chronic viral hepatitis ; hepatocellular carcinoma

PublicationName

台灣醫學

Volume or Term/Year and Month of Publication

26卷3期(2022 / 05 / 25)

Page #

313 - 321

Content Language

繁體中文

Chinese Abstract

代謝症候群(metabolic syndrome, MetS)逐漸受到重視,其重要性在於一般人口中極為盛行,並且會引發全身各器官疾患,包括在肝臟表現的非酒精性脂肪肝病(non-alcoholic fatty liver disease, NAFLD)以及非酒精性脂肪肝炎(non-alcoholic steatohepatitis, NASH)。非酒精性脂肪肝病廣義地涵蓋了病理學上單純脂肪浸潤(steatosis)、非酒精性脂性肝炎、纖維化(fibrosis)甚至於肝硬化(cirrhosis)等不同嚴重程度的肝傷害,臨床上卻無喝酒過量的病史。在台灣,隨著經濟的發展,以及飲食習慣的西化,肥胖、糖尿病以及高血脂症的人口越來越多,代謝症候群以及非酒精性脂肪肝病已經大家相當重視的問題。脂肪肝意指「肝內的脂肪(主要是三酸甘油酯)含量超過全肝重量的5%」。診斷非酒精性脂性肝炎最基本的條件包括脂肪浸潤(steatosis),肝細胞膨脹(ballooning)和肝小葉發炎(lobular inflammation)。亞太地區非酒精性脂肪肝病相當常見。最近大型回顧文章指出,一般人口非酒精性脂肪肝病的盛行率在12-40%之間,在台灣,社區成人族群以及接受健康檢查的一般民眾中,脂肪肝病的盛行率在12-37%之間。亞太地區B型與C型肝炎盛行,同時合併代謝症候群與脂肪肝患者不在少數。最近回顧文章指出,B型肝炎族群非酒精性脂肪肝病的盛行率在15-50%之間。本綜論將針對非酒精性脂肪肝病的診斷與流行病學加以闡述。

English Abstract

Metabolic Syndrome (MetS) is prevalent in the general population and can cause diseases of various organs, including Non-Alcoholic Fatty Liver Disease (NAFLD) and non-alcoholic steatohepatitis (Non-Alcoholic SteatoHepatitis, NASH). Non-alcoholic fatty liver disease pathologically covers simple steatosis, NASH, fibrosis and even cirrhosis; but no clinical history of excessive drinking. In Taiwan, with the westernization of eating habits, the population of obesity, diabetes and hyperlipidemia is increasing. Fatty liver means "the content of fat (mainly triglycerides) in the liver exceeds 5% of the whole liver weight". Essential criteria for the diagnosis of NASH include fatty infiltration (steatosis), hepatocyte swelling (ballooning) and lobular inflammation. NAFLD is fairly common in Asia Pacific. A recent large review article pointed out that the prevalence of NAFLD in the general population is between 12 and 40%. In Taiwan, the prevalence of fatty liver disease is between 12% and 37% among community adults and the general population undergoing health checks. Hepatitis B and C are prevalent in the Asia-Pacific region, and there are many patients with metabolic syndrome and fatty liver. A recent review article pointed out that the prevalence of nonalcoholic fatty liver disease in the hepatitis B population ranges from 15 to 50%. This review will address the diagnosis and epidemiology of nonalcoholic fatty liver disease.

Topic Category 醫藥衛生 > 醫藥衛生綜合
Reference
  1. Pan WH, Yeh WT, Weng LC. Epidemiology of metabolic syndrome in Asia. Asia Pac J Clin Nutr 2008;17(S1):37-42.
    連結:
  2. Yeh CJ, Chang HY, Pan WH. Time trend of obesity, the metabolic syndrome and related dietary pattern in Taiwan: from NAHSIT 1993-1996 to NAHSIT 2005-2008. Asia Pac J Clin Nutr 2011;20:292-300.
    連結:
  3. Sanyal AJ, American Gastroenterological Association: AGA technical review on nonalcoholic fatty liver disease. Gastroenterology 2002;123:1705-25.
    連結:
  4. American Gastroenterological Association Medical Position Statement: Nonalcoholic fatty liver disease. Gastroenterology 2002;123:1702-4.
    連結:
  5. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002;346:1221-31.
    連結:
  6. Koh JC, Loo WM, Goh KL, et al. GOASIA Workgroup. Asian Consensus on the relationship between obesity and gastrointestinal and liver diseases. J Gastroenterol Hepatol 2016;31:1405-13.
    連結:
  7. Wong VW, Chan WK, Chitturi S, et al. The Asia-Pacific Working Party on Nonalcoholic Fatty Liver Disease Guidelines 2017 Part 1: Definition, risk factors and assessment. J Gastroenterol Hepatol 2018;33:70-85.
    連結:
  8. Chitturi S, Wong VW, Chan WK, et al. The Asia-Pacific Working Party on Nonalcoholic Fatty Liver Disease Guidelines 2017 Part 2: Management and special groups. J Gastroenterol Hepatol 2018;33:86-98.
    連結:
  9. Fan JG, Kim SU, Wong VW. New trends on obesity and NAFLD in Asia. J Hepatol 2017;67:862-73.
    連結:
  10. 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;67:328-57.
    連結:
  11. Vos MB, Abrams SH, Barlow SE, et al. NASPGHAN Clinical Practice Guideline for the Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease in Children: Recommendations From the Expert Committee on NAFLD (ECON) and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). J Pediatr Gastroenterol Nutr 2017;64:319-34.
    連結:
  12. Farrell GC. Non-alcoholic steatohepatitis: what is it, and why is it important in the Asia-Pacific region? J Gastroenterol Hepatol 2003;18;124-38.
    連結:
  13. Brunt EM. Nonalcoholic steatohepatitis: Definition and pathology. Semin Liver Dis 2001;21:3-16.
    連結:
  14. Chen CH, Huang MH, Yang JC, et al. Prevalence and risk factors of nonalcoholic fatty liver disease in an adult population of Taiwan: metabolic significance of nonalcoholic fatty liver disease in nonobese adults. J Clin Gastroenterol 2006;40:745-52.
    連結:
  15. Day CP, James OF. Steatohepatitis: a tale of two “hit”? Gastroenterology 1998;114:842-5.
    連結:
  16. Wang CC, Cheng PN, Kao JH. Systemic review: chronic viral hepatitis and metabolic derangement. Aliment Pharmacol Ther 2020;51:216-30.
    連結:
  17. Liu CJ, Chen PJ, Jeng YM, et al. Serum adiponectin correlates with viral characteristics but not histologic features in patients with chronic hepatitis C. J Hepatol 2005;43:235-42.
    連結:
  18. Hsu CS, Liu CJ, Liu CH, et al. High hepatitis C viral load is associated with insulin resistance in patients with chronic hepatitis C. Liver Int 2008;28:271-7.
    連結:
  19. Hsu CS, Liu CJ, Liu CH, et al. Metabolic profiles in patients with chronic hepatitis C: a case–control study. Hepatol Int 2008;2:250-7.
    連結:
  20. Hsu CS, Liu CH, Liu CJ et al. Association of lipid profiles with hepatitis C viral load in chronic hepatitis C patients with genotype 1 or 2 infection. Am J Gastroenterol 2009;104:598-604.
    連結:
  21. Huang JF, Dai CY, Hwang SJ, et al. Hepatitis C viremia increases the association with type 2 diabetes mellitus in a hepatitis B and C endemic area: an epidemiological link with virological implication. Am J Gastroenterol 2007;102:1237-43.
    連結:
  22. Miyanari Y, Atsuzawa K, Usuda N, et al. The lipid droplet is an important organelle for hepatitis C virus production. Nature Cell Biol 2007;9:1089-1097.
    連結:
  23. Dai CY, Chuang WL, Ho CK, et al. Associations between hepatitis C viremia and low serum triglyceride and cholesterol levels: a community-based study. J Hepatol 2008;49:9-16.
    連結:
  24. Cheng PN, Chen JY, Chiu YC, et al. Augmenting central arterial stiffness following eradication of HCV by direct acting antivirals in advanced fibrosis patients. Sci Rep 2019;9:1426.
    連結:
  25. Wang CC, Hsu CS, Liu CJ, et al. Association of chronic hepatitis B virus infection with insulin resistance and hepatic steatosis. J Gastroenterol Hepatol 2008;23:779-82.
    連結:
  26. Chen CL, Yang HI, Yang WS, et al. Metabolic factors and risk of hepatocellular carcinoma by chronic hepatitis B/C infection: A follow-up study in Taiwan. Gastroenterology 2008;135:111-21.
    連結:
  27. Yu MW, Lin CL, Liu CJ, et al. Influence of metabolic risk factors on risk of hepatocellular carcinoma and liver-related death in men with chronic hepatitis B: A large cohort study. Gastroenterology 2017;153:1006-17.
    連結:
  28. Huang SF, Chang IC, Hong CC, et al. Metabolic risk factors are associated with non-hepatitis B non-hepatitis C hepatocellular carcinoma in Taiwan, an endemic area of chronic hepatitis B. Hepatol Commun 2018;2:747-59.
    連結:
  29. Dixon JB, Bhathal PS, Hughes NR, et al. Nonalcoholic fatty liver disease: improvement in liver histological analysis with weight loss. Hepatology 2004;39:1647-54.
    連結:
  30. Wong WS, Wong GL, Chan RS, et al. Beneficial effects of lifestyle intervention in non-obese patients with non-alcoholic fatty liver disease. J Hepatol 2018;69:1349-56.
    連結:
  31. Bugianesi E, Gentilcore E, Manini R, et al. A randomized controlled trial of metformin versus vitamin E or prescriptive diet in nonalcoholic fatty liver disease. Am J Gastroenterol 2005;100:1082-90.
    連結:
  32. Ratziu V, Friedman SL. Why do so many NASH trials fail? Gastroenterology 2020;S0016-5085(20)30680-6.
    連結:
  33. Alkhouri N. NASH and NAFLD: Emerging drugs, therapeutic targets and translational and clinical challenges. Expert Opin Investig Drugs 2020;29:87.
    連結:
  34. Younossi ZM, Ratziu V, Loomba R, et al. Obeticholic acid for the treatment of non-alcoholic steatohepatitis: Interim analysis from a multicenter, randomized, placebo-controlled phase 3 trial. Lancet 2019;394:2184-96.
    連結:
  35. Eslam M, Newsome PN, Sarin, et al. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement. J Hepatol 2020;73:202-9.
    連結:
  36. Ludwig J, Viggiano TR, McGill DB, et al. Nonalcoholic steatohepatitis: Mayo Clinic experience with a hitherto unnamed disease. Mayo Clin Proc 1980;55:434-8.
  37. Liu CJ, Jeng YM, Chen PJ, et al. Influence of metabolic syndrome, viral genotype and antiviral therapy on superimposed fatty liver disease in chronic hepatitis C. Antivir Ther 2005;10:405-15.