Nichtalkoholische Fettlebererkrankung

Zusammenfassung

Die nichtalkoholische Fettlebererkrankung (NAFLD), eine führende Ursache chronischer Lebererkrankungen, ist typischerweise assoziiert mit Adipositas, Diabetes mellitus Typ 2 oder Dyslipidämie und kann als hepatische Manifestation des Metabolischen Syndroms angesehen werden. Das Spektrum reicht von der Leberverfettung (NAFL) über die nichtalkoholische Steatohepatitis (NASH) zur Zirrhose mit Komplikationen, inklusive eines Leberzellkarzinoms. Eine Insulinresistenz ist entscheidend für die Entwicklung einer NAFLD. Faktoren wie Endotoxin oder Mediatoren wie toxische Lipide, TNF-alpha oder IL-6 aus dem viszeralen Fettgewebe sind an der Nekroinflammation bei NASH beteiligt. Die Prognose bei NAFL ist günstig, bei einer NASH sind die Risiken für kardiovaskuläre und hepatische Folgeschäden erhöht. Die Behandlung zielt ab auf Kontrolle der Risikofaktoren, Identifikation der Patienten mit fortgeschrittener Fibrose/Zirrhose für die Überwachung und das Management der Komplikationen. Gewichtsreduktion und gesteigerte körperliche Aktivität sind effektive Behandlungsmöglichkeiten und Vitamin E 800 IU/d kann als Mittel der Wahl bei der Pharmakotherapie einer NASH angesehen werden.

Summary

Non-alcoholic fatty liver disease (NAFLD) has become the leading cause of chronic liver disease. It is associated with type 2 diabetes mellitus, obesity, or dyslipidemia and can be considered as the hepatic manifestation of the metabolic syndrome. NAFLD encompasses a histological spectrum ranging from simple steatosis (NAFL) to non-alcoholic steatohepatitis (NASH), and ultimately cirrhosis with its sequelae including hepatocellular carcinoma. Insulin resistance has a key role in NAFLD, and gut–derived signals, e.g. endotoxin, as well as adipose tissue- derived factors, e.g. toxic lipids, TNF-alpha, IL-6, all have been implicated in the pathogenesis of NASH. While NAFL carries a relatively benign prognosis, the risk of cardiovascular as well as liver-related events is increased in individuals with NASH. Treatment of NAFLD aims at a modification of underlying risk factors, detection of patients with advanced fibrosis or cirrhosis with appropriate surveillance and management of related complications. Weight reduction and exercise are effective treatment options for NAFLD patients, and only vitamin E at a dose of 800 IU/day should be considered as first-line pharmacotherapy in NASH.

Schlüsselwörter

NAFLD - NASH - Metabolisches Syndrom - Adipositas

Keywords

NAFLD - NASH - metabolic syndrome - obesity

• Literatur

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