非酒精性脂肪肝的临床诊断与治疗进展课件

非酒精性脂肪性肝炎主讲人:杨梅非酒精性脂肪性肝炎1Mpulation()Generacoulston(N-35435.0Employees(N=1581enerapopulaton(N=3175netal,20020minisatMeofficers(N=4009)USGenerapoulationIN=32日Kacamakyeta.2004elderlyWN=134etaL200enera∞图Omagaiat碱,200234ardH-Cerveraeta,2006-1Medcoeta.2005UnitadSateGenerapopulaton(N-22871nyalocholINtrenzymesGenerapopulation[M=1°6ASTOALTorGGT4.7Clarketal.2003-8UnitedSatesRepwreoftheU.sASTOALTRuhletal200°Deaths.generaPopulatonAutopsy3016PorosisNAweliverdonorsIN=2631Biopsy1%NASHBntetal声ASHnarukamistethemUS,utAnotapplicableCT,computedtomograph:MS,magnetcMedscape2MNAFLDPrevalenceType2daberersnatentsN=2809695Desch-Diatlenetal2006Garrbmatin-Gewwanetal,2007UnitadStatesPeieystieeuarysyndrome(N-8UntedStatesChanicLvarDnaseRegtryWN=7421US/C39.1IverenzymeaLiangpunsakuetal2005"opulation,Dionsstud断BanacncsurgerypatentsIN=112)Blcpsy55了NAsH16tboBanatncsurgerypabentsN=14676041.1NASHChileBalancsurgerypatentsN=127Bid≈e0NAsH15arrowsMoiledetal2008/ranceType2dabetes+USpositiveWN=32)Biapsy2004BalanesurgurypatientN=1003.0ForessHsomn。钬ta,20044Bc720725NACH2.fboeBruntetaP3BiopsyLievenal,2006osananasurgerypaBiopsy96.oNAsH260brosntedstatesBanatnesurgerypabentsIN=16untetar26NASH313fbrossONASH120ngetal2005edStatesBalancsurgerypatent26.0NASH/3.0fibrosisBiopsy440NASH'80cirrhosisModrindstatchepatieUs,ulusound:CI,computedtomographNAnotapplet:ALT,anneamnomanstese:HCv,hepatisCvrus:NASH-CHN,sanaeehslestMedscape3RiskfactorAuthor(year)ReferencenoAge>50yearsGarcia-Monzonetal.(2000)137Ratziueta/.(2000)Anguloetal.(1999)ObesityWanless可ta.(1990)Ratziueta/.(2000)138Anguloetal.(1999)Type2diabetesWanlesseta/.(1990)Anguloeral.(1999)个GradesWanlesseta/.(1990)inflammationGarcia-Monzonetal.(2000)137Ratziueta/.(2000)HypertensionWillnereta/.(2001140Dixonetal.(2001)142AST/ALTratic≥1Anguloetal.(1999)Sorbieta/.(1999)144Georgeetal.(1998)DegreeofWanlesseta/.(1990)139steatosis,TfreeGarcia-Monzonetal.(2000137fattyacidsmillnereta/.(2001)Triglycerides>Ratziueta/.(2000)ALT>2>normRatziueta/.(2000)188Dixoneta/.(2001)Riskfactor4脂肪肝的基本概念狭义的定义肝内甘油三酯储积>肝脏湿重的5%,光镜下每单位面积见>30%的肝实质细胞出现脂变,称为脂肪性肝病(fattyliverdiseasefld),简称脂肪肝。脂肪肝的基本概念5根据病情进展的疾病谱分为单纯性脂肪肝(nonalcoholicfattyliverNAFL)脂肪性肝炎(nonalcoholicsteatohepatitisNASH脂肪性肝硬化正常肝肝硬化Fattycirrhosis根据病情进展的疾病谱分为6Ga←脂肪肝分类根据脂肪变性累及范围弥漫性脂肪肝(急性和慢性)局灶性脂肪肝弥漫性脂肪肝伴正常肝岛根据病因酒精性脂肪肝(alcoholicliverdiseaseAlD)非酒精性脂肪肝(nonalcoholicfattyliverdiseasenafld)Ga7NAFLD的病因insulinresistanceglucoseintoleranceDiabetescentralobeseysllpldaemlahypertensionHowever,afterexclusionofahistoryofsignificantalcoholintake,whichisconventionally<20g/dayNAFLD的病因8NAFLD的病因nutritionalcauses:rapidweightlossandtotalparenteralnutritionraremetabolicdisordersanddrug-inducedsteatosis.Commonlyimplicatedagents:glucocorticoidsamiodarone,syntheticoestrogensandhighlyactiveantiretroviraldrugs(haartSteatosisisalsofrequentlyassociatedwithhepatitisC,particularlygenotype3,andendocrinedisorderssuchaspolycysticovarysyndrome(PCOS),hypopituitarismandhypothyroidismNAFLD的病因9PrimayNAFLDConditionsassociatedwithinsulinesisancesyndrometype2diabetes,obesity,hyperlipaemiaSecondaryNAFLDDrugsSurgicalproceduresOtherconditonsTotalparenteralnutton,environmentaltoxins,Weber-CristiandseaseIncertainnAFldintestinalbacterialovergrowthIcnovercadPrimayNAFLD10非酒精性脂肪肝的临床诊断与治疗进展课件11非酒精性脂肪肝的临床诊断与治疗进展课件12非酒精性脂肪肝的临床诊断与治疗进展课件13非酒精性脂肪肝的临床诊断与治疗进展课件14非酒精性脂肪肝的临床诊断与治疗进展课件15非酒精性脂肪肝的临床诊断与治疗进展课件16非酒精性脂肪肝的临床诊断与治疗进展课件17非酒精性脂肪肝的临床诊断与治疗进展课件18非酒精性脂肪肝的临床诊断与治疗进展课件19非酒精性脂肪肝的临床诊断与治疗进展课件20非酒精性脂肪肝的临床诊断与治疗进展课件21非酒精性脂肪肝的临床诊断与治疗进展课件22非酒精性脂肪肝的临床诊断与治疗进展课件23非酒精性脂肪肝的临床诊断与治疗进展课件24非酒精性脂肪肝的临床诊断与治疗进展课件25非酒精性脂肪肝的临床诊断与治疗进展课件26非酒精性脂肪肝的临床诊断与治疗进展课件27非酒精性脂肪肝的临床诊断与治疗进展课件28非酒精性脂肪肝的临床诊断与治疗进展课件29非酒精性脂肪肝的临床诊断与治疗进展课件30非酒精性脂肪肝的临床诊断与治疗进展课件31非酒精性脂肪肝的临床诊断与治疗进展课件32非酒精性脂肪肝的临床诊断与治疗进展课件33非酒精性脂肪肝的临床诊断与治疗进展课件34非酒精性脂肪肝的临床诊断与治疗进展课件35非酒精性脂肪肝的临床诊断与治疗进展课件36非酒精性脂肪肝的临床诊断与治疗进展课件37非酒精性脂肪肝的临床诊断与治疗进展课件38非酒精性脂肪肝的临床诊断与治疗进展课件39非酒精性脂肪肝的临床诊断与治疗进展课件40非酒精性脂肪肝的临床诊断与治疗进展课件41非酒精性脂肪肝的临床诊断与治疗进展课件42非酒精性脂肪肝的临床诊断与治疗进展课件43非酒精性脂肪肝的临床诊断与治疗进展课件44非酒精性脂肪肝的临床诊断与治疗进展课件45非酒精性脂肪肝的临床诊断与治疗进展课件46非酒精性脂肪肝的临床诊断与治疗进展课件47非酒精性脂肪肝的临床诊断与治疗进展课件48非酒精性脂肪肝的临床诊断与治疗进展课件49非酒精性脂肪肝的临床诊断与治疗进展课件50非酒精性脂肪肝的临床诊断与治疗进展课件51非酒精性脂肪肝的临床诊断与治疗进展课件52非酒精性脂肪肝的临床诊断与治疗进展课件53非酒精性脂肪肝的临床诊断与治疗进展课件54非酒精性脂肪肝的临床诊断与治疗进展课件55非酒精性脂肪肝的临床诊断与治疗进展课件56非酒精性脂肪肝的临床诊断与治疗进展课件57非酒精性脂肪肝的临床诊断与治疗进展课件58非酒精性脂肪肝的临床诊断与治疗进展课件59非酒精性脂肪肝的临床诊断与治疗进展课件60非酒精性脂肪肝的临床诊断与治疗进展课件61非酒精性脂肪肝的临床诊断与治疗进展课件62非酒精性脂肪肝的临床诊断与治疗进展课件63非酒精性脂肪肝的临床诊断与治疗进展课件64非酒精性脂肪肝的临床诊断与治疗进展课件65非酒精性脂肪性肝炎主讲人:杨梅非酒精性脂肪性肝炎66Mpulation()Generacoulston(N-35435.0Employees(N=1581enerapopulaton(N=3175netal,20020minisatMeofficers(N=4009)USGenerapoulationIN=32日Kacamakyeta.2004elderlyWN=134etaL200enera∞图Omagaiat碱,200234ardH-Cerveraeta,2006-1Medcoeta.2005UnitadSateGenerapopulaton(N-22871nyalocholINtrenzymesGenerapopulation[M=1°6ASTOALTorGGT4.7Clarketal.2003-8UnitedSatesRepwreoftheU.sASTOALTRuhletal200°Deaths.generaPopulatonAutopsy3016PorosisNAweliverdonorsIN=2631Biopsy1%NASHBntetal声ASHnarukamistethemUS,utAnotapplicableCT,computedtomograph:MS,magnetcMedscape67MNAFLDPrevalenceType2daberersnatentsN=2809695Desch-Diatlenetal2006Garrbmatin-Gewwanetal,2007UnitadStatesPeieystieeuarysyndrome(N-8UntedStatesChanicLvarDnaseRegtryWN=7421US/C39.1IverenzymeaLiangpunsakuetal2005"opulation,Dionsstud断BanacncsurgerypatentsIN=112)Blcpsy55了NAsH16tboBanatncsurgerypabentsN=14676041.1NASHChileBalancsurgerypatentsN=127Bid≈e0NAsH15arrowsMoiledetal2008/ranceType2dabetes+USpositiveWN=32)Biapsy2004BalanesurgurypatientN=1003.0ForessHsomn。钬ta,20044Bc720725NACH2.fboeBruntetaP3BiopsyLievenal,2006osananasurgerypaBiopsy96.oNAsH260brosntedstatesBanatnesurgerypabentsIN=16untetar26NASH313fbrossONASH120ngetal2005edStatesBalancsurgerypatent26.0NASH/3.0fibrosisBiopsy440NASH'80cirrhosisModrindstatchepatieUs,ulusound:CI,computedtomographNAnotapplet:ALT,anneamnomanstese:HCv,hepatisCvrus:NASH-CHN,sanaeehslestMedscape68RiskfactorAuthor(year)ReferencenoAge>50yearsGarcia-Monzonetal.(2000)137Ratziueta/.(2000)Anguloetal.(1999)ObesityWanless可ta.(1990)Ratziueta/.(2000)138Anguloetal.(1999)Type2diabetesWanlesseta/.(1990)Anguloeral.(1999)个GradesWanlesseta/.(1990)inflammationGarcia-Monzonetal.(2000)137Ratziueta/.(2000)HypertensionWillnereta/.(2001140Dixonetal.(2001)142AST/ALTratic≥1Anguloetal.(1999)Sorbieta/.(1999)144Georgeetal.(1998)DegreeofWanlesseta/.(1990)139steatosis,TfreeGarcia-Monzonetal.(2000137fattyacidsmillnereta/.(2001)Triglycerides>Ratziueta/.(2000)ALT>2>normRatziueta/.(2000)188Dixoneta/.(2001)Riskfactor69脂肪肝的基本概念狭义的定义肝内甘油三酯储积>肝脏湿重的5%,光镜下每单位面积见>30%的肝实质细胞出现脂变,称为脂肪性肝病(fattyliverdiseasefld),简称脂肪肝。脂肪肝的基本概念70根据病情进展的疾病谱分为单纯性脂肪肝(nonalcoholicfattyliverNAFL)脂肪性肝炎(nonalcoholicsteatohepatitisNASH脂肪性肝硬化正常肝肝硬化Fattycirrhosis根据病情进展的疾病谱分为71Ga←脂肪肝分类根据脂肪变性累及范围弥漫性脂肪肝(急性和慢性)局灶性脂肪肝弥漫性脂肪肝伴正常肝岛根据病因酒精性脂肪肝(alcoholicliverdiseaseAlD)非酒精性脂肪肝(nonalcoholicfattyliverdiseasenafld)Ga72NAFLD的病因insulinresistanceglucoseintoleranceDiabetescentralobeseysllpldaemlahypertensionHowever,afterexclusionofahistoryofsignificantalcoholintake,whichisconventionally<20g/dayNAFLD的病因73NAFLD的病因nutritionalcauses:rapidweightlossandtotalparenteralnutritionraremetabolicdisordersanddrug-inducedsteatosis.Commonlyimplicatedagents:glucocorticoidsamiodarone,syntheticoestrogensandhighlyactiveantiretroviraldrugs(haartSteatosisisalsofrequentlyassociatedwithhepatitisC,particularlygenotype3,andendocrinedisorderssuchaspolycysticovarysyndrome(PCOS),hypopituitarismandhypothyroidismNAFLD的病因74PrimayNAFLDConditionsassociatedwithinsulinesisancesyndrometype2diabetes,obesity,hyperlipaemiaSecondaryNAFLDDrugsSurgicalproceduresOtherconditonsTotalparenteralnutton,environmentaltoxins,Weber-CristiandseaseIncertainnAFldintestinalbacterialovergrowthIcnovercadPrimayNAFLD75非酒精性脂肪肝的临床诊断与治疗进展课件76非酒精性脂肪肝的临床诊断与治疗进展课件77非酒精性脂肪肝的临床诊断与治疗进展课件78非酒精性脂肪肝的临床诊断与治疗进展课件79非酒精性脂肪肝的临床诊断与治疗进展课件80非酒精性脂肪肝的临床诊断与治疗进展课件81非酒精性脂肪肝的临床诊断与治疗进展课件82非酒精性脂肪肝的临床诊断与治疗进展课件83非酒精性脂肪肝的临床诊断与治疗进展课件84非酒精性脂肪肝的临床诊断与治疗进展课件85非酒精性脂肪肝的临床诊断与治疗进展课件86非酒精性脂肪肝的临床诊断与治疗进展课件87非酒精性脂肪