非酒精性脂肪肝课件

1、非酒精性脂肪性肝病的中药治疗胡欣 江苏省中西医结合医院 内分泌科内容概要NAFLD的定义与流行病学NAFLD的危害NAFLD的治疗NAFLD的定义与流行病学NAFLD是一种与胰岛素抵抗和遗传易感密切相关的代谢应激性肝损伤，疾病谱包括非酒精性单纯性肝脂肪变、非酒精性脂肪性肝炎（NASH）、肝硬化和肝细胞癌（HCC）。NAFLD的定义与流行病学疾病定义NAFLD肝脏病理学和影像学改变与酒精性肝病相似，但无过量饮酒等导致肝脂肪变的其他原因，患者通常存在营养过剩、肥胖和 MetS相关表现非酒精性不饮酒或无过量饮酒史（过去12个月男性每周饮用乙醇210g，女性140g），未应用胺碘酮、甲氨蝶呤、他莫昔芬

2、、糖皮质激素等药物，并排除基因3型丙型肝炎病毒（HCV）感染、肝豆状核变性、自身免疫性肝炎、全胃肠外营养、乏脂蛋白血症、先天性脂质萎缩症、乳糜泻等可以导致脂肪肝的特定疾病非酒精性脂肪肝变又称单纯性脂肪肝，是NAFLD的早期表现，大泡性或大泡为主的脂肪变累及 5%以上肝细胞，可以伴有轻度非特异性炎症NASHNAFLD的严重类型，5%以上的肝细胞脂肪变合并小叶内炎症和肝细胞气球样变性。NAFLD相关肝硬化有肥胖症、MetS、T2DM和（或）NAFLD病史的隐源性肝硬化世界范围内普通人群NAFLD发病率为28.01-52.341000人/年NAFLD是全球最常见的慢性肝病，普通成人NAFLD 患病率

3、介于 6.3%45%，其中10%30%为NASH中东和南美洲NAFLD患病率最高，非洲最低，包括中国在内的亚洲多数国家 NAFLD 患病率处于中上水平（25%）NAFLD的定义与流行病学Younossi ZM, et al. Hepatology. 2016, 64:73-84.NAFLD的定义与流行病学Younossi Z, et al. Nat Rev Gastroenterol Hepatol. 2018,15(1):11-20.NAFLD的定义与流行病学Younossi ZM, et al. Hepatology. 2016, 64:73-84.NAFLD的定义与流行病学Younoss

4、i ZM, et al. Hepatology. 2016, 64:73-84.NAFLD的危害25%30%41%10%单纯脂肪变17.6亿脂肪肝炎5亿肝硬化/肝细胞癌2亿NAFLD并非良性病变，而是一种进展性疾病 Arab JP, et al. Annu Rev Pathol. 2018, 13:321-350.NAFLD的危害Adams LA, et al. Gut. 2017, 66(6):1138-1153.NAFLD的危害Younossi ZM, et al. Hepatology. 2016, 64:73-84.NAFLD的危害2017年NATURE杂志呼吁：应高度重视NAFLDN

5、AFLD的治疗非药物治疗药物治疗NAFLD的治疗非药物治疗药物治疗NAFLD的治疗Weight loss generally reduces HS, achieved either by hypocaloric diet alone or in conjunction with increased physical activity. A combination of a hypocaloric diet (daily reduction by 500-1,000 kcal) and moderate-intensity exercise is likely to provide the be

6、st likelihood of sustaining weight loss over time.Weight loss of at least 3%-5% of body weight appears necessary to improve steatosis, but a greater weight loss (7%-10%) is needed to improve the majority of the histopathological features of NASH, including fibrosis.Exercise alone in adults with NAFL

7、D may prevent or reduce HS, but its ability to improve other aspects of liver histology remains unknownYounossi ZM, et al. Hepatology. 2016, 64:73-84.NAFLD的治疗非药物治疗药物治疗NAFLD的治疗西药治疗中药治疗药物治疗NAFLD的西药治疗胰岛素增敏剂格列酮类二甲双胍01维生素E02减肥药GLP-1RA奥利司他西布曲明03FXR受体激动剂04他汀类05大麻受体阻滞剂、抗氧化应激等06Kaser S, et al. Int J Clin Pra

8、c. 2010, 64: 968-83. NAFLD的西药治疗Rinella ME. JAMA. 2015, 313:2263-73.NAFLD的西药治疗Rotman Y, et al. Gut. 2017, 66(1):180-190.NAFLD的中药治疗小檗碱中药方：扶正化瘀胶囊、利肝石榴八味散、降脂胶囊、护肝清脂片、健肝宝（云芝、丹参、五味子）、胆宁片、化痰祛湿汤、血府逐瘀汤、葛根芩连汤、四逆散等食物及其提取物：白藜芦醇、佛手柑多酚、宁夏枸杞多糖、薯蓣皂苷、辣椒素、大蒜烯丙半胱氨酸、芍药苷、二氢杨梅素、杠柳毒苷A、芦丁等中药：甘草酸、水飞蓟素、珠子草、柴胡、苦参、丹参、黄芩、五味子、黄芪

9、、三七、绞股蓝、五味子、姜黄、山楂、黄精等1. Liu ZL, et al. Cochrane Database Syst Rev. 2013, 24(8):CD009059.2. Hong M, et al. Int J Mol Sci. 2015, 16(12):28705-45.3. Yao H, et al. World J Gastroenterol. 2016, 22(30):6890-905. NAFLD的中药治疗-小檗碱（BBR）Wei X, et al. Evid Based Complement Alternat Med. 2016;2016:3593951.NAFLD的中

10、药治疗-小檗碱（BBR）Wei X, et al. Evid Based Complement Alternat Med. 2016;2016:3593951.NAFLD的中药治疗-小檗碱（BBR）Chang X, Gao X, et al. J Transl Med. 2016, 14:266. NAFLD的中药治疗-小檗碱（BBR）Sun Y, Gao X, et al. Br J Pharmacol. 2018, 175(2):374-387. NAFLD的中药治疗-小檗碱（BBR）NAFLD的中药治疗-小檗碱（BBR）NAFLD的中药治疗-小檗碱（BBR）Zhu X, Gao X, e

11、t al. Molecules. 2016, 21(10).pii: E1336.小檗碱调控肝脏糖脂代谢关键通路降低肝脏脂肪含量上调FGF21增加自噬降低线粒体功能亢进、减少氧化应激调节肠道菌群NAFLD的中药治疗-降脂胶囊Zhao Y, et al. J Transl Med. 2015, 13:174. NAFLD的中药治疗-降脂胶囊Zhao Y, et al. J Transl Med. 2015, 13:174. NAFLD的中药治疗-降脂胶囊Zhao Y, et al. J Transl Med. 2015, 13:174. NAFLD的中药治疗-降脂胶囊Zhao Y, et al.

12、 J Transl Med. 2015, 13:174. NAFLD的中药治疗-利肝石榴八味散Jiang Y, et al. J Ethnopharmacol. 2015, 176:499-507.NAFLD的中药治疗-利肝石榴八味散Jiang Y, et al. J Ethnopharmacol. 2015, 176:499-507.NAFLD的中药治疗-利肝石榴八味散Jiang Y, et al. J Ethnopharmacol. 2015, 176:499-507.NAFLD的中药治疗-利肝石榴八味散Jiang Y, et al. J Ethnopharmacol. 2015, 176:499-507.NAFLD的中药治疗-利肝石榴八味散Jiang Y, et al. J Ethnopharmacol. 2015, 176:499-507.NAFLD的中药治疗-中药提取物Zhao Y, et al. J Transl Med. 2015, 13:174. NAFLD的中药治疗-五味子1. Zhu PL, et al. Drug Des Devel Ther. 2015, 9:923-35.2. Jang MK, et al. J Ethnopharmacol. 2016, 185:96-104. 总结NAFLD是一种与胰岛素抵抗和遗传易感密切相关的代谢应激性肝损伤，