非酒精性脂肪肝诊治指南

非酒精性脂肪肝诊治指南

Journal of Digestive Diseases 2008; 9; 108–112doi: 10.1111/j.1751-2980.2008.00331.x

Guidelines for the diagnosis and treatment of nonalcoholic

fatty liver diseases*

Min De ZENG,* Jian Gao FAN, Lun Gen LU,* You Ming LI, Cheng Wei CHEN,§

Bing Yuan WANG¶ & Yi Min MAO*

*Shanghai Institute of Digestive Disease, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, Department of Gastroenterology, Shanghai First People’s Hospital, Jiaotong University, Shanghai,

Department of Gastroenterology, First Af liated Hospital, Zhejiang University School of Medicine, Hangzhou,

§

Clinical Center for Hepatology, No. 85 Army Hospital, Shanghai, ¶Department of Gastroenterology,

First Af liated Hospital, China Medical University, Shenyang, China

Nonalcoholic fatty liver disease (NAFLD) is a clinicaland pathological syndrome. The main characteristic isdiffuse ballooning fatty degeneration of hepatocytesinduced by pathologic factors except alcohol and otherknown factors that injure liver. NAFLD includes simplefatty liver and nonalcoholic steatohepatitis (NASH) withor without liver cirrhosis. Insulin resistance and geneticsusceptibility are closely correlated with NAFLD.Following the greatly increased incidence of obesityand diabetes, NAFLD has become one of the commonchronic diseases in our country, severely harming thepeople’s health. For standardizing the diagnosis, treat-ment and therapeutic effect evaluation of NAFLD, theFatty Liver and Alcoholic Liver Disease Study Group ofthe Chinese Society of Hepatology organized expertsin this eld to work out guidelines for the diagnosisand treatment of nonalcoholic fatty liver diseases(abbreviated to ‘guidelines’) with reference to thelatest worldwide research data and in accordancewith the principles of evidence-based medicine. Theevidence base categorized into three grades and velevels (Table 1), presented as italicized Rome digitsin parentheses.1

These guidelines aim only to help physicians to makethe correct decision in diagnosing and treating NAFLD.

Correspondence to: Min De ZENG, Shanghai Institute of Digestive Disease, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200001, China. Email: xhsyljd@http://www.77cn.com.cn

*The Chinese National Consensus Workshop on nonalcoholic fatty liver diseases was organized by Chinese Society of Hepatology, Chinese Medical Association. 2008 The Authors

Journal compilation 2008 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology and Blackwell Publishing Asia Pty Ltd.

They do not constitute a compulsory standard andcannot include or resolve all problems in the diagnosisand treatment of NAFLD. For this reason, when con-fronting an individual patient, clinicians should beable to make a reasonable diagnostic and therapeuticscheme by understanding suf ciently the best clinicalevidence and available medical resources with respectto their patients’ speci c condition and wishes, and inaccordance with their own knowledge and experience.Because of the rapid research progress of NAFLD, theguidelines should be renewed and improved regularlyon demand.

CRITERIA OF CLINICAL DIAGNOSIS2–5

NAFLD can be diagnosed if the following items 1–5coexist with the sixth or seventh item.

1.There is no history of drinking alcohol, or ethanol

intake per week is less than 140 g in men and 70 gin women.2.Speci c diseases that could result in fatty liver,

such as viral hepatitis, drug-induced liver disease,total parenteral nutrition and Wilson’s disease,can be ruled out.3.Besides clinical manifestations of the primary dis-ease, other non-speci c symptoms and signs, suchas fatigue, dyspepsia, dull liver pain and hepato-splenomegaly occur.4.Metabolic syndrome constituents such as over-weight and/or visceral obesity, hyperglycemia,blood lipid disorder and hypertension occur.

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非酒精性脂肪肝诊治指南

Journal of Digestive Diseases 2008; 9; 108–112

Table 1.

Categorization of evidence bases

Diagnosis and treatment of nonalcoholic fatty liver diseases109

Evidence gradeIII-1II-2II-3III

Type of evidence

Randomized control study

Non-randomized control studyCohort or case-control study

Serial studies at different times, with no controls

Opinions and experiences of experts and authorities, epidemiological description

5.Serum levels of transaminase and γ-glutamyl

transpeptidase increase mildly to moderately(<5 times above the upper normal limit), usuallypresenting as an increase of alanine aminotrans-ferase (ALT).6.The result of liver imaging study meets the imag-ing diagnostic criteria of diffuse fatty liver.7.The histological ndings of liver biopsy meet the

pathological diagnostic criteria of fatty liver disease.CRITERIA OF CLINICAL TYPING4,6,7Simple nonalcoholic fatty liver

Simple nonalcoholic fatty liver can be diagnosed if thefollowing items 1–2 and any one of item 3 or 4 coexist.1.Presence of items 1–3 of the criteria of clinical

diagnosis mentioned above.2.Basically normal value in hepatic biochemical

tests.3.Manifestations of liver-imaging study meet the

diagnostic criteria of fatty liver.4.Histological ndings meet the diagnostic criteria

of simple fatty liver.NASH

NASH can be diagnosed if the following items 1–3 oritem 1 and item 4 coexist.

1.Presence of items 1–3 of the clinical diagnosis

criteria listed above.2.Presence of metabolic syndrome or rise of serum

ALT of unknown causes for more than 4 weeks.3.Manifestations of liver-imaging study meet the

diagnostic criteria of diffuse fatty liver.4.Histological ndings meet the diagnostic criteria

of steatohepatitis.

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