非酒精性脂肪性肝病的药物治疗进展

非酒精性脂肪性肝病已日渐成为目前慢性肝病的主要病因,其与肥胖、2型糖尿病和代谢综合征等疾病密切相关,疾病谱主要包括非酒精性单纯性脂肪肝、非酒精性脂肪性肝炎和肝硬化。早期诊断和及时治疗可望减轻NAFLD患者肝炎的严重程度并延缓肝纤维化的进展,减少并发症的出现。目前认为其发病与胰岛素抵抗、氧化应激及脂质过氧化和肠道菌群失调等因素有关。通过饮食调整和适当运动而减轻体重被认为是最基础的治疗措施,但单纯依靠减肥治疗脂肪性肝病(FLD)的效果并不理想,药物在脂肪性肝炎防治中的作用同样不可忽视。目前没有根治这一疾病的特效药物,单纯针对某一发病机制的药物亦难以治愈NAFLD这种复杂的疾病,本文主要从改善胰岛素抵抗、降脂、保肝抗炎及改善肠道菌群等四方面介绍一下本病的药物治疗进展。提倡改变生活方式的非药物治疗与药物干预治疗紧密结合,以取得最理想的治疗效果。

Progress of Drug Therapy of Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease（NAFLD）has been increasingly recognized as the most common cause of chronic liver disease. It is associated with obesity, type 2 diabetes mellitus （DM）and metabolic syndrome. Its spectrum of disease includes steatosis, nonalcoholic steatohepatitis （NASH） and cirrhosis. Diagnosis earlier and prompt treatment can reduce the severity of NAFLD, delay the progress of liver fibrosis and reduce the incidence of complications. The Pathogenesis includes insulin resistance, oxidative stress agents, the intestinal flora and so on. Appropriate exercise and weight loss are the basic treatment, but drugs can＇t be ignored in the treatment of steatohepatitis. Currently there is no very effective drugs for this disease, drugs ony for one kind of pathogenesis can not cure NAFLD. We mainly report the drug therapy of NAFLD, including four aspects： improving insulin resistant, reducing lipid, applying liver-protective agents and keeping balance in gut microbiata.