dfefew: 脂肪肝是心腦血管病的早期預警

脂肪肝是心腦血管病的早期預警


10 Aug 2023 at 03:29pm
 脂肪肝是由於各種原因導致肝臟中脂肪過度增加,超過肝濕重的5%。能讓肝“發胖”的原因很多,例如過量飲酒引起酒精性肝病、代謝紊亂引起非酒精性脂肪性肝病等。

  非酒精性脂肪性肝病通常簡稱為脂肪肝,是一個不斷進展的系列性疾病。從單純只有脂肪沉積的非酒精性脂肪性肝病,大約25%的患者可進展至非酒精性脂肪性肝炎。

非酒精性脂肪性肝炎是一個需要積極藥物治療的疾病,而不是僅僅依靠生活方式改善就能控制。非酒精性脂肪性肝炎患者中,約10%的人可進展至非酒精性脂肪性肝纖維化及肝硬化,其中1%—5%的患者可能發展成非酒精性脂肪性肝病相關肝癌。

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  全球範圍內非酒精性脂肪性肝病的流行病學調查顯示,發達國家的發病率趨於平穩,但發展中國家的發病率在顯著上升。綜合我國各地的流行病學調查數據,非酒精性脂肪性肝病的發病率約為29%。

  由於肝臟具有強大的代償功能,肝臟疾病在早期通常沒有任何臨床症狀。所以,肝臟是個沉默的器官。患有非酒精性脂肪性肝病和非酒精性脂肪性肝炎的人,也常常沒有不舒服的感覺。大部分人通過體檢發現脂肪肝後也不予重視,更不會到醫院就診。

  然而,非酒精性脂肪性肝病可以進展為非酒精性脂肪性肝炎,其表現是肝功能出現異常,尤其是在肝髒彈性測定檢查時,除了代表肝臟內脂肪沉積的CAP值增加,還會出現肝臟彈性測定檢查的硬度值增加。這提示肝臟出現了纖維化,日積月累,未來可能發展成非酒精性脂肪性肝病相關肝硬化甚至肝癌。

非酒精性脂肪性肝病患者因代謝異常,較普通人更容易出現高脂血症、糖尿病、高血壓等代謝相關性疾病,導致冠心病、腦卒中的發生率顯著增加。因此,脂肪肝是心腦血管疾病的早期預警信號,應該高度重視。

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  數據顯示,肥胖患者中患有脂肪肝的比例遠高於其他人群,超過一半的肥胖患者患有脂肪肝。此外,2型糖尿病患者也是發生非酒精性脂肪性肝病的高風險人群。研究表明,2型糖尿病合併非酒精性脂肪性肝病的患者中,嚴重的肝臟纖維化的比例更高,也更易患心血管疾病。因此,2型糖尿病患者和體型超重肥胖的人,更應該高度關注肝臟健康。

  事實上,大多數非酒精性脂肪性肝病患者可以通過改變生活方式來減少肝臟中的脂肪,逆轉疾病,如適當減重、堅持健康飲食等。但如果肝臟已經發生了炎症甚至出現纖維化,進展至非酒精性脂肪性肝炎,此時單純通過改變生活方式,就很難恢復健康了,需要進行進一步診斷和治療。

  建議體檢時發現脂肪肝的患者,一定要到醫院接受相關全面檢查,包括肝臟功能、血壓、血糖、血脂、肝髒彈性測定等,了解脂肪肝的嚴重程度,明確診斷,評估疾病的嚴重程度,並接受改善生活方式的專業指導。已經明確為非酒精性脂肪性肝炎的患者,更應該進行針對代謝異常的相關治療,阻止疾病進展。

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