However,applying similar logic would force one to conclude that asymptomatic individuals with a blood pressure of 180/100 mm Hg, a fasting blood sugar of 180 mg/dL, or low density lipoproteins of 200 mg/dL, while abnormal, do not have a disease state
Lipodystrophy
Inflammatory bowel disease
Protein-calorie malnutrition Salicylates
Dysbetalipoproteinemia HIV* infection
Starvation
Calcium channel blockers Weber-Christian disease Small bowel diverticulosis
* Defining nonalcoholic fatty liver disease: implications for epidemiologic studies.
Gastroenterology. 2003 Jan;124(1):248-50. Review.

“still waters run deep.”
病理
Two patterns of hepatic steatosis
: (1) microvesicular steatosis: the (2) macrovesicular steatosis: the
cytoplasm is replaced by bubbles cytoplasm is replaced by a large
疾病谱
病因
单纯性脂肪肝
脂肪性肝炎
脂肪性肝硬化
酒精性肝病
NAFLD
原发性
继发性
流行病学
Indeed, the preponderance of asymptomatic individuals with fatty liver has tempted some to conclude that fatty liver alone may be a variant of normalcy, rather than a true disease
Total parenteral nutrition Amiodarone
Wolman's disease
随着社会经济发展，非酒精性脂肪性肝病 （NAFLD）患病率迅速增高，现已成为危 害人类健康的三大肝病之一
NAFLD与失代偿期肝硬化、肝功能衰竭、 原发性肝癌的发生密切相关
在美国，NAFLD是转氨酶长期增高及隐源 性肝硬化最常见的原因*
*Clark JM, Diehl AM. Nonalcoholic fatty liver disease: an underrecognized cause
病因
Causes of Nonalcoholic Fatty Liver Disease
Nutritional
Drugs
Metabolic/Genetic
Other
Obesity
Corticosteroids
Wilson's disease
Environmental hepatotoxins
Type 2 diabetes mellitus Estrogens
of fat that do not displace the
bubble of fat that displaces the
nucleus
nucleus to the edge of the cell
* From Sanyal AJ. Nonalcoholic steatohepatitis. Clinical Perspectives in
非酒精性脂肪性肝病的诊断与治疗
概念
Fatty liver (hepatic steatosis)
Excessive accumulation of lipid in hepatocytes, the most common response of the liver to injury.
脂肪肝(定义)
Gastroenterology. 2000;129
Steatohepatitis is shown here. The histologic findings shown include macrovesicular steatosis, cytologic ballooning, Mallory bodies, and scattered lobular inflammation
of cryptogenic cirrhosis. JAMA ,2003，289 :3000-3004
• 研究表明，肥胖是NAFLD的独立危险因素
• 肥胖者中NAFLD的发生率约为50%，其中， 单纯性脂肪肝30%，非酒精性脂肪性肝炎 （NASH）24-30.5%，肝纤维化28%，肝 硬化1.5-8%
Mallory body is shown within a ballooned hepatocyte
Pericellular fibrosis is shown (Masson's trichrome stain). The collagenous tissue (shown in blue) surrounds individual hepatocytes, producing a chicken-wire appearance.
• 这种与肥胖相关的NAFLD已成为全球普遍 关注的医学问题和社会问题
• NAFLD可能为欧美等发达国家第一大肝病， 成人脂肪肝患病率高达20％～30％，其中 10％或2％～3％的成人为NASH，约1/3 NASH病人并发进展性肝纤维化和肝硬化。 肥胖人群的发生率更高
• 儿童NAFLD/NASH发病率亦不断增高， NASH青少年肝纤维化发生率70%，并有肝 硬化发生