非酒精性脂肪性肝病防治指南（2018年更新版）

doi:10.3969/j.issn.1672-5069.2018.02.007

Abstract

National Workshop on Fatty Liver, Alcoholic Liver Disease, Chinese Society of Hepatology, Chinese Medical Association; Fatty Liver Expert Committee, Chinese Medical Doctor Association. Guidelines of prevention and treatment for nonalcoholic fatty liver disease:a 2018 update[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(2): 177-186.

References

[1] Rinella ME.Nonalcoholic fatty liver disease:a systematic review[J].JAMA,2015,313(22):2263-2273. DOI:10.1001/jama.2015.5370
[2] Diehl AM,Day C.Cause,pathogenesis,and treatment of nonalcoholic steatohepatitis[J]. N Engl J Med,2017,377(21):2063-2073. DOI:10.1056/NEJMra1503519.
[3] Wang FS,Fan JG,Zhang Z,et al.The global burden of liver disease:the major impact of China[J]. Hepatology,2014,60(6):2099-2108. DOI:10.1002/hep.27406.
[4] Fan JG,Kim SU,Wong VW.New trends on obesity and NAFLD in Asia[J]. J Hepatol,2017,67(4):862-873. DOI:10.1016/j.jhep.2017.06.003.
[5] Wang MM,Wang GS,Shen F,et al.Hepatic steatosis is highly prevalent in hepatitis B patients and negatively associated with virological factors[J]. Dig Dis Sci,2014,59(10):2571-2579. DOI:10.1007/s10620-014-3180-9.
[6] Fan JG,Jia JD,Li YM,et al.Guidelines for the diagnosis and management of nonalcoholic fatty liver disease:update 2010:(published in Chinese on Chinese Journal of Hepatology 2010;18:163-166)[J]. J Dig Dis,2011,12(1):38-44. DOI: 10.1111/j.1751-2980.2010.00476.x.
[7] Review Team,LaBrecque DR,Abbas Z,et al.World Gastroenterology Organisation global guideline:Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis[J]. J Clin Gastroenterol,2014,48(6):467-473. DOI:10.1097/MCG.0000000000000116.
[8] Wong VW,Chan WK,Chitturi S,et al.Asia-Pacific Working Party on Non-alcoholic Fatty Liver Disease Guidelines 2017-Part 1:Definition,risk factors and assessment[J]. J Gastroenterol Hepatol,2018,33(1):70-85. DOI:10.1111/jgh.13857.
[9] 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[J]. Hepatology,2018,67(1):328-357. DOI:10.1002/hep.29367.
[10] European Association for the Study of the Liver,European Association for the Study of Diabetes,European Association for the Study of Obesity.Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease[J]. J Hepatol,2016,64(6):1388-1402.
[11] Younossi ZM,Koenig AB,Abdelatif D,et al.Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence,incidence,and outcomes[J]. Hepatology,2016,64(1):73-84. DOI:10.1002/hep.28431.
[12] Zhu JZ,Zhou QY,Wang YM,et al.Prevalence of fatty liver disease and the economy in China:A systematic review[J]. World J Gastroenterol,2015,21(18):5695-5706.DOI:10.3748/wjg.v21.i18.5695.
[13] Wong VW,Wong GL,Yeung DK,et al.Incidence of non-alcoholic fatty liver disease in Hong Kong:a population study with paired proton-magnetic resonance spectroscopy[J]. J Hepatol,2015,62(1):182-189. DOI:10.1016/j.jhep.2014.08.041.
[14] Xu C,Yu C,Ma H,et al.Prevalence and risk factors for the development of nonalcoholic fatty liver disease in a nonobese Chinese population:the Zhejiang Zhenhai Study[J]. Am J Gastroenterol,2013,108(8):1299-1304. DOI:10.1038/ajg.2013.104.[15] Kwok R,Choi KC,Wong GL,et al. Screening diabetic patients for non-alcoholic fatty liver disease with controlled attenuation parameter and liver stiffness measurements:a prospective cohort study[J].Gut,2016,65(8):1359-1368. DOI10.1136/gutjnl-2015-309265.
[16] Zhang RN,Zheng RD,Mi YQ,et al.APOC3 rs2070666 is associated with the hepatic steatosis independently of PNPLA3 rs738409 in Chinese Han patients with nonalcoholic fatty liver diseases[J].Dig Dis Sci,2016,61(8):2284-2293. DOI:10.1007/s10620-016-4120-7.
[17] Xu L,Ma H,Miao M,et al.Impact of subclinical hypothyroidism on the development of non-alcoholic fatty liver disease:a prospective case-control study[J].J Hepatol,2012,57(5):1153-
1154. DOI:10.1016/j.jhep.2012.05.025.
[18] Xu C,Yu C,Xu L,et al.High serum uric acid increases the risk for nonalcoholic Fatty liver disease:a prospective observational study[J]. PLoS One,2010,5(7):e11578. DOI:10.1371/journal.pone.0011578.
[19] Ma H,Xu C,Xu L,et al.Independent association of HbA1c and nonalcoholic fatty liver disease in an elderly Chinese population[J].BMC Gastroenterol,2013,13:3. DOI: 10.1186/1471-230X-
13-3.
[20] Xu C,Wan X,Xu L,et al.Xanthine oxidase in non-alcoholic fatty liver disease and hyperuricemia:One stone hits two birds[J]. J Hepatol,2015,62(6):1412-1419. DOI:10.1016/j.jhep.2015.01.019.
[21] Dulai PS,Singh S,Patel J,et al.Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease:Systematic review and meta-analysis[J].Hepatology,2017,65(5):1557-1565. DOI:10.1002/hep.29085.
[22] Leung JC,Loong TC,Wei JL,et al.Histological severity and clinical outcomes of nonalcoholic fatty liver disease in nonobese patients[J].Hepatology,2017,65(1):54-64.DOI: 10.1002/hep.28697.
[23] Wang Y,Wang B,Shen F,et al.Body mass index and risk of primary liver cancer:a meta-analysis of prospective studies[J].Oncologist,2012,17(11):1461-1468.DOI: 10.1634/theoncologist.2012-0066.
[24] Wong VW,Wong GL,Yeung JC,et al.Long-term clinical outcomes after fatty liver screening in patients undergoing coronary angiogram:A prospective cohort study[J].Hepatology,2016,63(3):754-763. DOI:10.1002/hep.28253.
[25] Ballestri S,Zona S,Targher G,et al.Nonalcoholic fatty liver disease is associated with an almost twofold increased risk of incident type 2 diabetes and metabolic syndrome. Evidence from a systematic review and meta-analysis[J].J Gastroenterol Hepatol,2016,31(5):936-944. DOI: 10.1111/jgh.13264.
[26] Chen GY,Cao HX,Li F,et al.New-risk-scoring system including non-alcoholic fatty liver disease for predicting incident type 2 diabetes in East China:Shanghai Baosteel Cohort[J].J Diabetes Investig,2016,7(2):206-211. DOI:10.1111/jdi.12395.
[27] Wu S,Wu F,Ding Y,et al.Association of non-alcoholic fatty liver disease with major adverse cardiovascular events:A systematic review and meta-analysis[J]. Sci Rep,2016,6:33386. DOI:10.1038/srep33386.
[28] Targher G,Byrne CD,Lonardo A,et al.Non-alcoholic fatty liver disease and risk of incident cardiovascular disease:A meta-analysis[J]. J Hepatol,2016,65(3):589-600.DOI:10.1016/j.jhep.2016.05.013.
[29] Wu R,Hou F,Wang X,et al.Nonalcoholic fatty liver disease and coronary artery calcification in a northern Chinese population:a cross sectional study[J]. Sci Rep,2017,7(1):9933. DOI:10.1038/s41598-017-09851-5.
[30] Musso G,Gambino R,Tabibian JH,et al.Association of non-alcoholic fatty liver disease with chronic kidney disease:a systematic review and meta-analysis[J]. PLoS Med,2014,11(7):e1001680. DOI: 10.1371/journal.pmed.1001680.
[31] Zeng J,Sun C,Sun WL,et al.Association between non-invasively diagnosed hepatic steatosis and chronic kidney disease in Chinese adults at a health check-up[J].J Dig Dis,2017,18(4):229-236. DOI:10.1111/1751-2980.12465.
[32] Ding W,Fan J,Qin J.Association between nonalcoholic fatty liver disease and colorectal adenoma:a systematic review and meta-analysis[J]. Int J Clin Exp Med,2015,8(1):322-333.
[33] Chitturi S,Wong VW,Chan WK,et al.The Asia-Pacific Working Party on Non-alcoholic Fatty Liver Disease guidelines 2017-Part 2:Management and special groups[J]. J Gastroenterol Hepatol,2018,33(1):86-98. DOI:10.1111/jgh.13856.
[34] European Association for Study of Liver,Asociacion Latinoamericana para el Estudio del Higado. EASL-ALEH Clinical Practice Guidelines:Non-invasive tests for evaluation of liver disease severity and prognosis[J].J Hepatol,2015,63(1):237-264. DOI:10.1016/j.jhep.2015.04.006.
[35] Xu L,Lu W,Li P,et al.A comparison of hepatic steatosis index,controlled attenuation parameter and ultrasound as noninvasive diagnostic tools for steatosis in chronic hepatitis B[J].Dig Liver Dis,2017,49(8):910-917. DOI:10.1016/j.dld.2017.03.013.
[36] Shen F,Zheng RD,Mi YQ,et al.Controlled attenuation parameter for non-invasive assessment of hepatic steatosis in Chinese patients[J].World J Gastroenterol,2014,20(16):4702-4711. DOI: 10.3748/wjg.v20.i16.4702.
[37] Shen F,Zheng RD,Shi JP,et al.Impact of skin capsular distance on the performance of controlled attenuation parameter in patients with chronic liver disease[J]. Liver Int,2015,35(11):2392-2400. DOI:10.1111/liv.12809.
[38] Karlas T,Petroff D,Sasso M,et al. Individual patient data meta-analysis of controlled attenuation parameter(CAP) technology for assessing steatosis[J]. J Hepatol,2017,66(5):1022-
1030. DOI:10.1016/j.jhep.2016.12.022.
[39] 沈峰,郑瑞丹,宓余强,等. 细胞角蛋白-18联合受控衰减参数二步法无创鉴别非酒精性脂肪性肝炎的临床研究[J]. 中华肝脏病杂志,2016,24(6):429-434. DOI:10.3760/cma.j.issn.1007-3418.2016.06.007.
[40] Bedossa P,FLIP Pathology Consortium.Utility and appropriateness of the fatty liver inhibition of progression (FLIP) algorithm and steatosis,activity,and fibrosis (SAF) score in the evaluation of biopsies of nonalcoholic fatty liver disease[J]. Hepatology,2014,60(2):565-575.DOI:10.1002/hep.27173.
[41] Xun YH,Fan JG,Zang GQ,et al.Suboptimal performance of simple noninvasive tests for advanced fibrosis in Chinese patients with nonalcoholic fatty liver disease[J].J Dig Dis,2012,13(11):588-595. DOI: 10.1111/j.1751-2980.2012.00631.x.
[42] Petta S,Wong VW,Cammà C,et al.Improved noninvasive prediction of liver fibrosis by liver stiffness measurement in patients with nonalcoholic fatty liver disease accounting for controlled attenuation parameter values[J]. Hepatology,2017,65(4):1145-1155. DOI:10.1002/hep.28843.
[43] 曾静,孙婉璐,陈光榆,等.FibroTouch与FibroScan肝脏硬度和脂肪定量检测效能的比较[J].中华肝脏病杂志,2016,24(9):652-658. DOI:10.3760/cma.j.issn.1007-3418.2016.09.004.
[44] Singh S,Muir AJ,Dieterich DT,et al.American Gastroenterological Association Institute Technical Review on the Role of Elastography in Chronic Liver Diseases[J]. Gastroenterology,2017,152(6):1544-1577. DOI: 10.1053/j.gastro.2017.03.016.
[45] Yu C,Xu C,Xu L,et al.Serum proteomic analysis revealed diagnostic value of hemoglobin for nonalcoholic fatty liver disease[J]. J Hepatol,2012,56(1):241-247. DOI:10.1016/j.jhep.2011.05.027.
[46] Nascimbeni F,Pais R,Bellentani S,et al.From NAFLD in clinical practice to answers from guidelines[J]. J Hepatol,2013,59(4):859-871.DOI:10.1016/j.jhep.2013.05.044.
[47] Romero-Gómez M,Zelber-Sagi S,Trenell M.Treatment of NAFLD with diet,physical activity and exercise[J]. J Hepatol,2017,67(4):829-846. DOI:10.1016/j.jhep.2017.05.016.
[48] Wong VW,Chan RS,Wong GL,et al.Community-based lifestyle modification programme for non-alcoholic fatty liver disease:a randomized controlled trial[J]. J Hepatol,2013,59(3):536-542. DOI:10.1016/j.jhep.2013.04.013.
[49] Fan JG,Cao HX.Role of diet and nutritional management in non-alcoholic fatty liver disease[J]. J Gastroenterol Hepatol,2013,28 Suppl 4:81-87. DOI: 10.1111/jgh.12244.
[50] Zhang HJ,He J,Pan LL,et al.Effects of Moderate and Vigorous Exercise on Nonalcoholic Fatty Liver Disease:A Randomized Clinical Trial[J]. JAMA Intern Med,2016,176(8):1074-1082. DOI:10.1001/jamainternmed.2016.3202.
[51] Zhang HJ,Pan LL,Ma ZM,et al.Long-term effect of exercise on improving fatty liver and cardiovascular risk factors in obese adults:A 1-year follow-up study[J]. Diabetes Obes Metab,2017,19(2):284-289. DOI:10.1111/dom.12809.
[52] Argo CK,Patrie JT,Lackner C,et al.Effects of n-3 fish oil on metabolic and histological parameters in NASH:a double-blind,randomized,placebo-controlled tria[J]. J Hepatol,2015,62(1):190-197. DOI:10.1016/j.jhep.2014.08.036.
[53] Athyros VG,Tziomalos K,Gossios TD,et al.Safety and efficacy of long-term statin treatment for cardiovascular events in patients with coronary heart disease and abnormal liver tests in the Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) Study:a post-hoc analysis[J]. Lancet,2010,376(9756):1916-1922. DOI:10.1016/S0140-6736(10)61272-X.
[54] Bril F,Portillo Sanchez P,Lomonaco R,et al.Liver safety of statins in prediabetes or T2DM and nonalcoholic steatohepatitis:post hoc analysis of a randomized trial[J]. J Clin Endocrinol Metab,2017,102(8):2950-2961. DOI: 10.1210/jc.2017-00867.
[55] Armstrong MJ,Gaunt P,Aithal GP,et al.Liraglutide safety and efficacy in patients with non-alcoholic steatohepatitis(LEAN):a multicentre,double-blind,randomised,placebo-controlled phase 2 study[J]. Lancet,2016,387(10019):679-690. DOI10.1016/S0140-
6736(15)00803-X.
[56] Cusi K,Orsak B,Bril F,et al.Long-term pioglitazone treatment for patients with nonalcoholic steatohepatitis and prediabetes or type 2 diabetes mellitus:a randomized trial[J]. Ann Intern Med,2016,165(5):305-315. DOI:10.7326/M15-1774.
[57] Brito JP,Montori VM,Davis AM.Metabolic surgery in the treatment algorithm for type 2 diabetes:a joint statement by international diabetes organizations[J]. JAMA,2017,317(6):635-636. DOI:10.1001/jama.2016.20563.
[58] Klebanoff MJ,Corey KE,Chhatwal J,et al.Bariatric surgery for nonalcoholic steatohepatitis:A clinical and cost-effectiveness analysis[J]. Hepatology,2017,65(4):1156-1164. DOI:10.1002/hep.28958.
[59] 中华医学会感染病学分会,肝脏炎症及其防治专家共识委员会.肝脏炎症及其防治专家共识[J]. 中华肝脏病杂志,2014,22(2):94-103. DOI:10.3760/cma.j.issn. 1007-3418.2014.02.006.
[60] Sanyal AJ,Chalasani N,Kowdley KV,et al.Pioglitazone,vitamin E,or placebo for nonalcoholic steatohepatitis[J]. N Engl J Med,2010,362(18):1675-1685.
[61] Neuschwander-Tetri BA,Loomba R,Sanyal AJ,et al.Farnesoid X nuclear receptor ligand obeticholic acid for non-cirrhotic,non-alcoholic steatohepatitis(FLINT):a multicentre,randomised,placebo-controlled trial[J]. Lancet,2015,385(9972):956-965.DOI:10.1016/S0140-6736(14)61933-4.
[62] Han Y,Shi JP,Ma AL,et al.Randomized,vitamin E-controlled trial of bicyclol plus metformin in non-alcoholic fatty liver disease patients with impaired fasting glucose[J]. Clin Drug Investig,2014,34(1):1-7.DOI: 10.1007/s40261-013-0136-3.
[63] Wah Kheong C,Nik Mustapha NR,Mahadeva S.A randomized trial of silymarin for the treatment of nonalcoholic steatohepatitis[J]. Clin Gastroenterol Hepatol,2017,15(12):1940-1949. DOI: 10.1016/j.cgh.2017.04.016.
[64] Newsome PN,Allison ME,Andrews PA,et al.Guidelines for liver transplantation for patients with non-alcoholic steatohepatitis[J].Gut,2012,61(4):484-500. DOI:10.1136/gutjnl-2011-300886.
[65] Pais R,Barritt AS 4th,Calmus Y,et al. NAFLD and liver transplantation:Current burden and expected challenges[J]. J Hepatol,2016,65(6):1245-1257. DOI:10.1016/j.jhep.2016.07.033.
[66] Ajmera VH,Terrault NA,Harrison SA.Is moderate alcohol use in nonalcoholic fatty liver disease good or bad A critical review[J]. Hepatology,2017,65(6):2090-2099. DOI:10.1002/hep.29055.

Guidelines of prevention and treatment for nonalcoholic fatty liver disease:a 2018 update

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