https://www.yiliao.com/index.php?action=history&feed=atom&title=%E9%9D%9E%E9%85%92%E7%B2%BE%E6%80%A7%E8%84%82%E8%82%AA%E8%82%9D
非酒精性脂肪肝 - 版本历史
2026-04-09T16:28:15Z
本wiki的该页面的版本历史
MediaWiki 1.35.1
https://www.yiliao.com/index.php?title=%E9%9D%9E%E9%85%92%E7%B2%BE%E6%80%A7%E8%84%82%E8%82%AA%E8%82%9D&diff=316153&oldid=prev
103.220.218.7：建立内容为“<div style="padding: 0 4%; line-height: 1.8; color: #1e293b; font-family: 'Helvetica Neue', Helvetica, 'PingFang SC', Arial, sans-serif; background-color: #ffffff…”的新页面
2026-02-02T02:49:17Z
<p>建立内容为“<div style="padding: 0 4%; line-height: 1.8; color: #1e293b; font-family: 'Helvetica Neue', Helvetica, 'PingFang SC', Arial, sans-serif; background-color: #ffffff…”的新页面</p>
<p><b>新页面</b></p><div><div style="padding: 0 4%; line-height: 1.8; color: #1e293b; font-family: 'Helvetica Neue', Helvetica, 'PingFang SC', Arial, sans-serif; background-color: #ffffff; max-width: 1200px; margin: auto;"><br />
<br />
<div style="margin-bottom: 30px; border-bottom: 1.2px solid #e2e8f0; padding-bottom: 25px;"><br />
<h1 style="color: #0f172a; margin-bottom: 15px; font-size: 1.8em;">非酒精性脂肪肝 (NAFLD)</h1><br />
<p style="font-size: 1.1em; margin: 10px 0; color: #334155; text-align: justify;"><br />
<strong>非酒精性脂肪肝</strong>（NAFLD），现国际共识更名为<strong>代谢功能障碍相关脂肪性肝病</strong>（MASLD），是指在除外酒精和其他明确损肝因素后，肝细胞内脂肪堆积过多（>5%）的临床病理综合征。它不是一种单一的疾病，而是一个病理谱系，从单纯的<strong>肝脏脂肪变性</strong>（NAFL）发展为<strong>非酒精性脂肪性肝炎</strong>（NASH/MASH），最终可能演变为<strong>[[肝硬化]]</strong>甚至<strong>[[肝细胞癌]]</strong>。<br />
<br>• <strong>核心驱动力：</strong> 与[[胰岛素抵抗]]和[[代谢综合征]]（肥胖、糖尿病、高血脂）互为因果。<br />
<br>• <strong>沉默的杀手：</strong> 早期通常无症状，NASH 阶段才会出现炎症损伤和纤维化，是目前全球慢性肝病的首要原因。<br />
</p><br />
</div><br />
<br />
<div class="medical-infobox mw-collapsible mw-collapsed" style="width: 100%; max-width: 320px; margin: 0 auto 35px auto; border: 1.2px solid #bae6fd; border-radius: 12px; background-color: #ffffff; box-shadow: 0 8px 20px rgba(0,0,0,0.05); overflow: hidden;"><br />
<br />
<div style="padding: 15px; color: #1e40af; background: linear-gradient(135deg, #e0f2fe 0%, #bae6fd 100%); text-align: center; cursor: pointer;"><br />
<div style="font-size: 1.2em; font-weight: bold; letter-spacing: 1.2px;">脂肪肝 (NAFLD)</div><br />
<div style="font-size: 0.7em; opacity: 0.85; margin-top: 4px; white-space: nowrap;">现名：MASLD (点击展开)</div><br />
</div><br />
<br />
<div class="mw-collapsible-content"><br />
<div style="padding: 25px; text-align: center; background-color: #f8fafc;"><br />
[Image:Diagram_of_healthy_liver_vs_fatty_liver_vs_cirrhosis]<br />
<div style="font-size: 0.8em; color: #64748b; margin-top: 12px; font-weight: 600;">病程演变：从变黄到变硬</div><br />
</div><br />
<br />
<table style="width: 100%; border-spacing: 0; border-collapse: collapse; font-size: 0.85em;"><br />
<tr><br />
<th colspan="2" style="padding: 8px 12px; background-color: #e0f2fe; color: #1e40af; text-align: left; font-size: 0.9em; border-top: 1px solid #bae6fd;">临床档案</th><br />
</tr><br />
<tr><br />
<th style="text-align: left; padding: 6px 12px; background-color: #f8fafc; color: #475569; border-bottom: 1px solid #e2e8f0; width: 35%;">ICD-10编码</th><br />
<td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">K76.0</td><br />
</tr><br />
<tr><br />
<th style="text-align: left; padding: 6px 12px; background-color: #f8fafc; color: #475569; border-bottom: 1px solid #e2e8f0;">主要风险</th><br />
<td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">[[2型糖尿病]]<br>[[中心性肥胖]]</td><br />
</tr><br />
<tr><br />
<th style="text-align: left; padding: 6px 12px; background-color: #f8fafc; color: #475569; border-bottom: 1px solid #e2e8f0;">金标准诊断</th><br />
<td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">肝穿刺活检</td><br />
</tr><br />
<tr><br />
<th style="text-align: left; padding: 6px 12px; background-color: #f8fafc; color: #475569;">新药突破</th><br />
<td style="padding: 6px 12px; color: #16a34a;">[[Resmetirom]] (2024获批)</td><br />
</tr><br />
</table><br />
</div><br />
</div><br />
<br />
<h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">病理机制：物流瘫痪的“仓库”</h2><br />
<br />
<div style="background-color: #f0f9ff; border-left: 5px solid #1e40af; padding: 15px 20px; margin: 20px 0; border-radius: 4px;"><br />
<h3 style="margin-top: 0; color: #1e40af; font-size: 1.1em;">二次打击假说 (Two-Hit Theory)</h3><br />
<p style="margin-bottom: 8px; text-align: justify; font-size: 0.95em; color: #334155;"><br />
<strong>第一重打击（堆积）：</strong> 肝脏就像人体的总仓库。当胰岛素抵抗发生时，外周脂肪分解增加，大量的货物（游离脂肪酸）涌入仓库，而仓库的运货卡车（VLDL）运力不足。货物堆积如山，形成单纯性脂肪肝。<br />
</p><br />
<p style="margin-bottom: 0; text-align: justify; font-size: 0.95em; color: #334155;"><br />
<strong>第二重打击（着火）：</strong> 堆积的脂肪开始发生脂质过氧化（腐烂变质），产生氧化应激反应，引来免疫细胞“放火”（炎症）。这导致肝细胞坏死和纤维化（仓库墙壁倒塌、修补留疤），这就变成了 NASH/MASH。<br />
</p><br />
</div><br />
<br />
<h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">从无害到致命的“红绿灯”</h2><br />
<br />
<div style="overflow-x: auto; margin: 20px auto;"><br />
<table style="width: 100%; border-collapse: collapse; border: 1.2px solid #cbd5e1; font-size: 0.9em; text-align: left;"><br />
<tr style="background-color: #f1f5f9; border-bottom: 2px solid #0f172a;"><br />
<th style="padding: 12px; border: 1px solid #cbd5e1; color: #0f172a; width: 20%;">阶段</th><br />
<th style="padding: 12px; border: 1px solid #cbd5e1; color: #475569;">病理特征</th><br />
<th style="padding: 12px; border: 1px solid #cbd5e1; color: #1e40af;">临床与预后</th><br />
</tr><br />
<tr><br />
<td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600; color: #16a34a;">NAFL<br>(单纯性)</td><br />
<td style="padding: 10px; border: 1px solid #cbd5e1;">仅有脂肪堆积，无炎症或极少。</td><br />
<td style="padding: 10px; border: 1px solid #cbd5e1; color: #334155;">预后良好，进展缓慢，通常无症状。</td><br />
</tr><br />
<tr><br />
<td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600; color: #ea580c;">NASH<br>(脂肪性肝炎)</td><br />
<td style="padding: 10px; border: 1px solid #cbd5e1;">脂肪 + <strong>炎症</strong> + <strong>气球样变</strong>。</td><br />
<td style="padding: 10px; border: 1px solid #cbd5e1; color: #334155;">转折点。若不干预，约 20% 进展为肝硬化。</td><br />
</tr><br />
<tr><br />
<td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600; color: #b91c1c;">Cirrhosis<br>(肝硬化)</td><br />
<td style="padding: 10px; border: 1px solid #cbd5e1;">广泛的纤维化结节，肝结构毁损。</td><br />
<td style="padding: 10px; border: 1px solid #cbd5e1; color: #334155;">不可逆。风险包括门脉高压、腹水、肝癌。</td><br />
</tr><br />
</table><br />
</div><br />
<br />
<h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">治疗：不仅是“少吃多动”</h2><br />
<br />
<ul style="padding-left: 25px; color: #334155;"><br />
<li style="margin-bottom: 12px;"><strong>减重（基石）：</strong> 减重 <strong>7-10%</strong> 是目前唯一证实能逆转 NASH 炎症和纤维化的非药物疗法。</li><br />
<li style="margin-bottom: 12px;"><strong>药物治疗：</strong><br />
<br> - <strong>Resmetirom：</strong> 2024年FDA批准的首个NASH特异性药物（THR-β激动剂），可减少肝脏脂肪毒性。<br />
<br> - <strong>GLP-1受体激动剂：</strong> （如[[司美格鲁肽]]）通过强效减重和抗炎作用改善脂肪肝。<br />
<br> - <strong>保肝药：</strong> 维生素 E（仅用于非糖尿病的 NASH 患者）和吡格列酮。</li><br />
</ul><br />
<br />
<div style="font-size: 0.92em; line-height: 1.6; color: #1e293b; margin-top: 50px; border-top: 2px solid #0f172a; padding: 15px 25px; background-color: #f8fafc; border-radius: 0 0 10px 10px;"><br />
<span style="color: #0f172a; font-weight: bold; font-size: 1.05em; display: inline-block; margin-bottom: 15px;">学术参考文献 [Academic Review]</span><br />
<br />
<p style="margin: 12px 0; border-bottom: 1px solid #e2e8f0; padding-bottom: 10px;"><br />
[1] <strong>Rinella ME, et al. (2023).</strong> <em>A multi-society Delphi consensus statement on new fatty liver disease nomenclature.</em> <strong>[[Journal of Hepatology]]</strong>. <br><br />
<span style="color: #475569;">[点评]：全球肝病学界发布的重磅共识，正式将 NAFLD 更名为 MASLD，强调了代谢异常在诊断中的核心地位。</span><br />
</p><br />
<br />
<p style="margin: 12px 0; border-bottom: 1px solid #e2e8f0; padding-bottom: 10px;"><br />
[2] <strong>Harrison SA, et al. (2024).</strong> <em>A Phase 3, Randomized, Controlled Trial of Resmetirom in NASH with Liver Fibrosis.</em> <strong>[[New England Journal of Medicine]]</strong>. <br><br />
<span style="color: #475569;">[点评]：MAESTRO-NASH 研究结果，证实了 Resmetirom 改善肝纤维化的有效性，促成了首款药物的获批。</span><br />
</p><br />
<br />
<p style="margin: 12px 0; border-bottom: 1px solid #e2e8f0; padding-bottom: 10px;"><br />
[3] <strong>Younossi ZM, et al. (2016).</strong> <em>Global epidemiology of nonalcoholic fatty liver disease.</em> <strong>[[Hepatology]]</strong>. <br><br />
<span style="color: #475569;">[点评]：流行病学经典文献，指出全球 NAFLD 患病率约为 25%，并预测了其作为肝移植病因的上升趋势。</span><br />
</p><br />
</div><br />
<br />
<div style="margin: 40px 0; border: 1px solid #e2e8f0; border-radius: 8px; overflow: hidden; font-family: 'Helvetica Neue', Arial, sans-serif; font-size: 0.9em;"><br />
<div style="background-color: #eff6ff; color: #1e40af; padding: 8px 15px; font-weight: bold; text-align: center; border-bottom: 1px solid #dbeafe;"><br />
脂肪肝 (NAFLD/MASLD) · 知识图谱<br />
</div><br />
<table style="width: 100%; border-collapse: collapse; background-color: #ffffff;"><br />
<tr style="border-bottom: 1px solid #f1f5f9;"><br />
<td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle;">上级概念</td><br />
<td style="padding: 10px 15px; color: #334155;">[[代谢综合征]] • 慢性非传染性疾病</td><br />
</tr><br />
<tr style="border-bottom: 1px solid #f1f5f9;"><br />
<td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle;">诊断工具</td><br />
<td style="padding: 10px 15px; color: #334155;">[[FibroScan]] (瞬时弹性成像) • [[CAP值]] (脂肪衰减) • [[肝活检]]</td><br />
</tr><br />
<tr style="border-bottom: 1px solid #f1f5f9;"><br />
<td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle;">关联机制</td><br />
<td style="padding: 10px 15px; color: #334155;">[[胰岛素抵抗]] • [[氧化应激]] • [[肠道菌群失调]]</td><br />
</tr><br />
<tr><br />
<td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle;">严重后果</td><br />
<td style="padding: 10px 15px; color: #334155;">[[肝硬化]] • [[肝细胞癌]] (HCC) • [[心血管疾病]]</td><br />
</tr><br />
</table><br />
</div><br />
<br />
</div></div>
103.220.218.7