AASLD发布NAFLD实践指南，用于筛查，治疗

StephenW

AASLD releases NAFLD practice guide for screening, treatment

Chalasani N, et al. Hepatol. 2017;doi:10.1002/hep.29367.
July 19, 2017

The AASLD released a practice guidance document for the diagnosis and management of nonalcoholic fatty liver disease. The document is based on a formal review of recently published international literature, the American College of Physicians’ Manual for Assessing Health Practices and Designing Practice Guidelines, and the expertise of authors and independent reviewers.

“There is a paucity of data regarding the incidence of NAFLD in the general population. ... The incidence rates for NAFLD in the general population of Western countries are even less commonly reported [than those in Asian countries],” the researchers wrote. “In contrast to the incidence data, there is a significantly higher number of publications describing the prevalence of NAFLD in the general population.”

According to the practice guide, the estimated overall global prevalence of NAFLD diagnosed by imaging is about 25.24% (95% CI, 22.1-28.65). The highest prevalence is 31.79% from the Middle East (95% CI, 13.48-58.23) and 30.45% from South America (95% CI, 22.74-39.44), while the lowest prevalence is 13.48% from Africa (95% CI, 5.69-28.69).

The guide provides detailed analyses of screening and treatment procedures for NAFLD to help clinicians understand and implement the most recent evidence. The guide covers the following topics and recommendations:

    While NAFLD indicates the lack of recent or regular alcohol consumption, a recent consensus meeting reviewing inconsistent data on alcohol consumption in NAFLD defined 21 standard drinks per week for men and 14 standard drinks per week for women as presenting an outstanding risk.
    Unsuspected or incidental hepatic steatosis detected on imaging should lead to further assessment of related causes.
    Routine screening is not typically recommended due to uncertainties in long-term benefits and cost-effectiveness, though initial evaluation of patients with suspected NAFLD should focus on competing comorbidities and coexisting liver disease.
    Tools such as the NAFLD Fibrosis Score, vibration controlled transient elastography and magnetic resonance elastography are recommended for identifying patients with higher likelihood of having or developing advanced fibrosis or cirrhosis.
    Liver biopsy is recommended in patients with NAFLD who are at increased risk for steatohepatitis or advanced fibrosis as determined by fibrosis score, elastography or competing etiologies.
    Pharmacological treatments should generally be limited to patients with biopsy-proven nonalcoholic steatohepatitis and fibrosis.
    Other potential interventions to decrease risk for NAFLD progression and to improve liver disease include lifestyle interventions, vitamin E administration in adults without diabetes, and bariatric surgery among patients with obesity.
    Patients with NAFLD should be monitored for cardiovascular risks as NAFLD increases the risk for cardiovascular morbidity and mortality.
    Patients with NAFLD should be screen for gastroesophageal varices and patients with NAFLD-related cirrhosis should be considered for hepatocellular screening.

The guidance concludes with reviewed data and statements regarding pediatric NAFLD. According to the researchers, children with fatty liver who are not overweight or are very young should be tested for monogenic causes of chronic liver disease. Liver biopsy in children with suspected NALFD should be performed in those with unclear diagnosis, those with the possibility for multiple diagnoses, and those with suspected NASH. Intensive lifestyle modification improves aminotransferases and liver histology and is recommended as the first line of treatment. – by Talitha Bennett

Disclosure: The funding for the development of this Practice Guidance was provided by the American Association for the Study of Liver Diseases.
Editor's note: This item has been updated to include magnetic resonance elastography among the recommended tools for identifying NAFLD.

StephenW

AASLD发布NAFLD实践指南，用于筛查，治疗

Chalasani N，et al。肝脏病。 2017; DOI：10.1002 / hep.29367。
2017年7月19日

AASLD发布了非酒精性脂肪性肝病的诊断和管理实践指导文件。该文件基于对最近出版的国际文献的正式审查，美国医师评估健康实践和设计实践指南手册以及作者和独立评审人员的专业知识。

“关于一般人群中NAFLD发病率的资料很少。研究人员写道，西方国家普通人群NAFLD的发病率甚至比亚洲国家普遍报道的少。 “与发病数据相反，出版物数量明显高于普通人群中的NAFLD患病率。”

根据实践指南，通过成像诊断的NAFLD的总体全球患病率估计为25.24％（95％CI，22.1-28.65）。来自中东的流行率最高（95％CI，13.48-58.23）和30.45％来自中东（95％CI，22.74-39.44），而非洲流行率最低（95％CI为5.69％） -28.69）。

该指南提供了NAFLD筛查和治疗程序的详细分析，以帮助临床医生了解和实施最新的证据。本指南涵盖以下主题和建议：

    虽然NAFLD表示缺乏最近或正常的酒精消费，但最近一项会议审查了NAFLD酒精消费不一致的数据，每周为男性定义21种标准饮料，每周定义14种标准饮料，以提高妇女的风险。
    在成像检测到的未预期或偶然的肝脂肪变性应导致进一步评估相关原因。
    由于长期效益和成本效益的不确定性，通常不推荐进行常规筛选，尽管对可疑NAFLD患者的初步评估应集中在竞争性并发症和共存肝脏疾病。
    推荐使用诸如NAFLD纤维化评分，振动控制弹性弹性成像和磁共振弹性成像等工具来识别具有或发展晚期纤维化或肝硬化的可能性较高的患者。
    在通过纤维化评分，弹性成像或竞争性病因测定的NAFLD患者中，推荐肝活检，其风险增加为脂肪性肝炎或晚期纤维化。
    药理治疗通常应限于经活检证实的非酒精性脂肪性肝炎和纤维化的患者。
    降低NAFLD进展风险和改善肝脏疾病的其他潜在干预措施包括生活方式干预，无糖尿病的成人中的维生素E给药以及肥胖患者的减肥手术。
    应监测NAFLD患者的心血管风险，因为NAFLD会增加心血管发病率和死亡率的风险。
    NAFLD患者应筛查胃食管静脉曲张，并应考虑NAFLD相关肝硬化患者进行肝细胞筛查。

指导结束后，审查了关于儿科NAFLD的数据和声明。据研究人员介绍，脂肪肝患儿不超重或年龄较小的患儿应进行慢性肝病单因素检测。疑似NALFD的儿童肝活检应在诊断不清，可能多诊断的患者和怀疑有NASH的患者中进行。强化生活习惯改善改善氨基转移酶和肝脏组织学，被推荐作为第一线治疗。 - 由Talitha Bennett

披露：本实践指南的制定资金由美国肝病研究协会提供。
编者注：此项目已更新为包括磁共振弹性成像在推荐的识别NAFLD的工具之间。