脂肪肝怎样治疗最好

脂肪肝如何治疗最好配图，仅供参考

10. Treatment
Treatment of NAFLD involves lifestyle modifications,treatment of comorbid medical conditions,as well as treatment of liver disease itself . Patients with NAFLD should be advised to lose weight through a combination of calorie reduction and exercise,as this has been shown to reduce hepatic steatosis . Additionally,NAFLD patients should be encouraged to limit heavy alcohol consumption,as more than 1.5 drinks (1 drink is defined as 12 ounces of beer,5 ounces of wine,or 1.5 ounces of liquor) a day has been shown to increase mortality in patient with NAFLD . Patients with comorbid diabetes and hyperlipidemia should be managed appropriately . Studies have found that patients with NAFLD are not at an increased risk of hepatotoxicity from statins,and thus,statins can be used in patients with comorbid hyperlipidemia,as long as patients do not have decompensated cirrhosis .
While limited treatment options directly addressing liver disease are available,several studies have investigated promising therapies that target inflammation,lipid metabolism,or fibrosis ). Vitamin E and pentoxifylline are two agents that have shown to reduce inflammation in patients with NASH. The Pioglitazone versus Vitamin E versus Placebo for the Treatment of Nondiabetic Patients with NASH (PIVENS) trial showed that vitamin E significantly reduced ALT and AST levels,hepatic steatosis,and lobular inflammation . It is recommended that patients with NASH without diabetes be prescribed 800 IU/day of Vitamin E for stage 2 fibrosis or higher . Pentoxifylline is a methylxanthine derivative that reduces inflammation and may have hepatoprotective effects . In a randomized placebo trial,pentoxifylline was shown to significantly reduce steatosis and lobular inflammation in patients with NASH .
# Table 7
Treatment.


Therapy
Mechanism



Weight loss and Exercise
Reduce hepatic steatosis


Treat comorbid conditions (obesity,diabetes,dyslipidemia)
Reduce hepatic steatosis


Limit heavy alcohol use
Decrease inflammation


Vitamin E (antioxidant)
Decrease inflammation


Pentoxifylline (methylxanthine derivative)
Decrease inflammation


Liraglutide (glucagon-like peptide-1 analogue)
Target lipid metabolism


Obeticholic acid (farnesoid X nuclear receptor activator)
Target lipid metabolism


Elafibranor (peroxisome proliferator-activated receptor agonist)
Target lipid metabolism


Cenicriviroc (dual antagonist of C–C motif chemokine receptor types 2 and 5)
Antifibrotic



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Agents currently being studied that target lipid metabolism in patients with NASH are Liraglutide (glucagon-like peptide-1 analogue),Obeticholic acid (farnesoid X nuclear receptor activator),and Elafibranor (peroxisome proliferator-activated receptor agonist) . Liraglutide is commonly used for treatment in diabetes . In the liraglutide safety and efficacy in patients with non-alcoholic steatohepatitis (LEAN) trial,liraglutide resulted in histological resolution of NASH . Obeticholic acid leads to activation of farnesoid X nuclear receptor,leading to decreased triglyceride levels. The Farnesoid X nuclear receptor ligand obeticholic acid for non-cirrhotic NASH (FLINT) trial showed that obeticholic acid improved histological features in patients with NASH . Elafibranor promotes fatty acid catabolism,which has been shown to improve dyslipidemia . Currently,Elafibranor is being compared to placebo in the RESOLVE-IT phase 3 clinical study .
Cenicriviroc is a dual antagonist of C–C motif chemokine receptor types 2 and 5 that has been shown to have antifibrotic properties by decreasing inflammation and collagen production at the site of liver injury . The Efficacy and Safety Study of Cenicriviroc for the Treatment of Nonalcoholic Steatohepatitis in Adult Participants with Liver Fibrosis (CENTAUR) phase 2 study showed that subjects treated with Cenicriviroc had double the improvement in fibrosis compared to placebo . Although promising,larger studies are still needed for the above mentioned therapies.","department":"