非酒精性脂肪性肝病的诊断与治疗

非酒精性脂肪性肝病的诊断与治疗

非酒精性脂肪性肝病（NAFLD）是一种常见的肝脏疾病，其诊断和治疗对于预防病情进展至关重要。本文将为您详细介绍NAFLD的诊断方法和治疗建议，帮助您更好地了解和管理这种疾病。

诊断方法

NAFLD通常不会引起明显症状，往往在检查其他肝脏问题时被发现。主要诊断方法包括：

血液检测

• 全血细胞计数
• 铁含量检测
• 肝酶和肝功能检测
• 慢性病毒性肝炎检查
• 乳糜泻筛查
• 空腹血糖和糖化血红蛋白检测
• 血脂分析

成像程序

• 腹部超声：通常作为初步检查手段
• 磁共振成像（MRI）或计算机体层成像（CT）扫描：适用于检测轻度肝纤维化
• 瞬时弹性成像：用于测量肝脏硬度
• 磁共振弹性成像：通过声波创建肝脏硬度的视觉图

肝脏活检

如果其他检查显示晚期肝病或NASH的迹象，医生可能会建议进行肝脏活检。虽然该手术有一定风险，但它是诊断NASH的最佳方法。

一位放射科医生在查看肝脏磁共振弹性图，显示红色的瘢痕形成区域。

治疗建议

NAFLD的治疗通常从减重开始，可通过健康饮食、限制食量和锻炼来实现。体重减轻10%或更多通常被推荐，但即使减轻3%-5%也可能有益。对于某些人群，减重手术或药物可能更有效。

目前，新药瑞司美替罗（Rezdiffra）可用于治疗伴有中度至重度肝脏瘢痕形成的NASH患者，但肝硬化患者不宜使用。严重情况下，可能需要进行肝移植。

生活方式调整

在医疗团队的指导下，患者可以采取以下措施管理NAFLD：

• 减重：通过健康饮食和增加运动量来逐步减轻体重
• 健康饮食：选择富含水果、蔬菜和全谷物的饮食，避免高糖和高脂肪食物
• 规律运动：每周至少进行150分钟的中等强度运动
• 控制糖尿病：遵循医生建议，控制血糖水平
• 降低胆固醇和血压：通过健康饮食、运动和必要时使用药物来维持正常水平
• 保护肝脏：避免饮酒，谨慎使用药物和补充剂

替代疗法

目前没有被证实能治愈NAFLD的替代疗法，但一些补充剂或天然化合物正在研究中：

• 维生素E：可能对未患2型糖尿病的NAFLD患者有效，但不建议肝硬化或2型糖尿病患者使用
• 含咖啡因的咖啡：研究表明咖啡可能有助于降低肝病风险，但具体机制尚不清楚

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本文原文来自Mayo Clinic