非酒精性脂肪肝病新進展课件.pptVIP

非酒精性脂肪肝病新進展The Update of Nonalcoholic Fatty Liver Disease 消化系內科 賴學洲 Case Presentation (1) 17 years old student (male) Height 162 cm, weight 85 kg Chief complaint: Abnormal liver function test Past history: No smoking and alcohol drinking Lab data: Anti-HCVAb(-), Anti-HBsAb(+), sugar 96 mg/dl. Cholesterol 165, TG 111 Abdominal echo Pathology Case presentation (2) 55 years old male Height: 165 cm weight:72 kg Chief complaint: Abnormal liver function test Past history: Smoking (-), Alcoholic drinking (-) Lab date: cholesterol 226, TG 132, sugar 76, ANA 1:40, AMA (-), Anti-smooth muscle Ab (-) Abdominal echo Pathology History Ludwig et al in 1980 -Obesity and diabetes could resulted in hepatic steatosis and fibrosis/cirrhosis -Liver pathology resembled those alcoholic liver disease Non Alcoholic Fatty Liver Disease 病理學上的表現和酒精性肝炎相似: 大囊泡狀脂肪變性 ( macrovesicular fatty change ) 局部肝細胞壞死 (necrosis) 急慢性發炎細胞混合侵潤 肝細胞膨脹(ballooning degeneration) 出現麥洛利氏小體 ( Mallory hyaline ) 部分患者有纖維化(fibrosis),甚至肝硬化(cirrhosis)的程度 沒有喝酒的習慣 大多是肥胖,糖尿病史及女性的患者 ? 將它命名為非酒精性脂肪性肝病 Non-alcoholic fatty liver disease or non-alcoholic steatohepatitis Non-alcoholic fatty liver disease (NAFLD) Non-alcoholic steatohepatitis(NASH) Moderate to severe necroinflammation Ballooning degeneration Mallory hyaline and/or fibrosis Semin. Liver Dis.2004;24;3-20 Fatty Liver Disease Fatty liver : 1.肝內脂肪(TG)含量超過肝重量 5 %. 2.肝主織切片超過10%以上的肝細胞有脂肪空泡堆積. Fatty liver : 1. Alcoholic liver disease 2. Non alcoholic liver disease Primary cause Secondary cause Non Alcoholic Fatty Liver Disease非酒精性脂肪肝病 廣義涵蓋: simple steatosis (單純脂肪變性) nonalcoholic steatohepatitis (非酒精性脂性肝炎) 有著與酒精性肝炎類似的病理變化但臨床上卻無酗酒的病史 如何與酒精性肝炎區隔: 男性每日飲用酒精20-40g. 女性每日飲用酒精20g以下. Pathogenesis 1985 年 Day and James 二次打擊假說 (two-hit hypothesis) 致病機轉-第一擊 胰島素抗性 血中胰島素增加會影響脂肪細胞及肝細胞的代謝 脂肪細胞方面 造成脂肪水解增加使送到肝細胞的游離脂肪酸增加 肝細胞方面 脂肪酸的合成會增加而脂肪酸的氧化受抑制 VLDL的apolipoprotein