特殊病因脂肪性肝炎的发病机制与早期诊断

摘要/Abstract

摘要： 脂肪性肝炎作为肝脏疾病的一种病理状态,易向进展期肝纤维化、肝硬化甚至肝细胞癌进展。此疾病不仅严重威胁患者的生命健康,也给社会带来沉重的医疗负担。目前,针对脂肪性肝炎的诊断和治疗多聚焦于酒精性肝病和代谢相关脂肪性肝病。然而,内分泌疾病、遗传性疾病、感染性疾病、药物性肝损伤、营养障碍等多种特殊病因也可导致成人及儿童发生脂肪性肝炎。同时,这些由特殊病因引发的脂肪性肝炎与代谢相关脂肪性肝病可能存在重叠。明确脂肪性肝炎的病因,有助于针对病因制定最适合的管理策略。本文结合国内外研究的最新进展,对由特殊病因导致的脂肪性肝炎进行综述,着重探讨其发病机制及早期诊断,有助于更精准地识别脂肪性肝炎的病因、降低风险,为脂肪性肝炎患者制定更精准的个性化管理方案。

关键词: 脂肪性肝炎, 代谢性疾病, 遗传性疾病, 早期诊断

宋林楠, 饶慧瑛. 特殊病因脂肪性肝炎的发病机制与早期诊断[J]. 肝脏, 2025, 30(11): 1454-1456.

/ 推荐

参考文献

[1] Zou H, Ge Y, Lei Q, et al. Epidemiology and disease burden of non-alcoholic steatohepatitis in greater China: a systematic review[J]. Hepatol Int, 2022, 16(1): 27-37.
[2] Khan M Q, Hassan S, Lizaola-Mayo B C, et al. Navigating the "specific etiology" steatohepatitis category: Evaluation and management of nonalcohol/nonmetabolic dysfunction-associated steatohepatitis[J]. Hepatology, 2025, 82(2): 504-521.
[3] Takahashi Y. Nonalcoholic fatty liver disease and adult growth hormone deficiency: an under-recognized association?[J]. Best Pract Res Clin Endocrinol Metab, 2023, 37(6): 101816.
[4] Yuen K C J, Biller B M K, Radovick S, et al. American Association of Clincal Endocrinologists and American College of Endocrinologists Guidelines for Management of Growth Hormone Deficiency in Adults and Patients Transitioning from Pediatric to Adult Care[J]. Endocr Pract, 2019, 25(11): 1191-1232.
[5] Sinha R A, Bruinstroop E, Yen P M. Actions of thyroid hormones and thyromimetics on the liver[J]. Nat Rev Gastroenterol Hepatol, 2025, 22(1): 9-22.
[6] Yang Y, Qi Z, Zhang T, et al. Rapidly progressive non-alcoholic fatty liver disease due to hypopituitarism. Report of 5 cases[J]. Neuro Endocrinol Lett, 2018, 39(2): 99-104.
[7] Sarkar M, Yates K, Suzuki A, et al. Low testosterone is associated with nonalcoholic steatohepatitis and fibrosis severity in men[J]. Clin Gastroenterol Hepatol, 2021, 19(2): 400-402.
[8] Bhasin S, Brito J P, Cunningham G R, et al. Testosterone therapy in men with hypogonadism: An Endocrine Society Clinical Practice Guideline[J]. J Clin Endocrinol Metab, 2018, 103(5): 1715-1744.
[9] Doycheva I, Ehrmann D A. Nonalcoholic fatty liver disease and obstructive sleep apnea in women with polycystic ovary syndrome[J]. Fertil Steril, 2022, 117(5): 897-911.
[10] Smyk W, Papapostoli I, Zorniak M, et al. Liver phenotypes in PCOS: analysis of exogenous and inherited risk factors for liver injury in two European cohorts[J]. Liver Int, 2023, 43(5): 1080-1088.
[11] Sarkar M, Brady C W, Fleckenstein J, et al. Reproductive health and liver disease: Practice Guidance by the American Association for the Study of Liver Diseases[J]. Hepatology, 2021, 73(1): 318-365.
[12] Byrne J J, Seasely A, Nelson D B, et al. Comparing acute fatty liver of pregnancy from hemolysis, elevated liver enzymes, and low platelets syndrome[J]. J Matern Fetal Neonatal Med, 2022, 35(7): 1352-1362.
[13] Schilsky M L, Roberts E A, Bronstein J M, et al. A multidisciplinary approach to the diagnosis and management of Wilson disease: executive summary of the 2022 Practice Guidance on Wilson disease from the American Association for the Study of Liver Diseases[J]. Hepatology, 2023, 77(4): 1428-1455.
[14] Schilsky M L, Roberts E A, Bronstein J M, et al. A multidisciplinary approach to the diagnosis and management of Wilson disease: Executive summary of the 2022 Practice Guidance on Wilson disease from the American Association for the Study of Liver Diseases[J]. Hepatology, 2023, 77(4): 1428-1455.
[15] Khodayari N, Wang R L, Oshins R, et al. The mechanism of mitochondrial injury in alpha-1 antitrypsin deficiency mediated liver disease[J]. Int J Mol Sci, 2021, 22(24).
[16] Narayanan P, Mistry P K. Update on alpha-1 antitrypsin deficiency in liver disease[J]. Clin Liver Dis (Hoboken), 2020, 15(6): 228-235.
[17] Schilsky M L, Roberts E A, Bronstein J M, et al. A multidisciplinary approach to the diagnosis and management of Wilson disease: Executive summary of the 2022 Practice Guidance on Wilson disease from the American Association for the Study of Liver Diseases[J]. Hepatology, 2023, 77(4): 1428-1455.
[18] Martin-Escolano R, Virseda-Berdices A, Berenguer J, et al. Predictive plasma biomarkers of long-term increase in hepatic steatosis index after HCV eradication in HIV/HCV-coinfected patients[J]. Biomed Pharmacother, 2023, 164: 114913.
[19] Villa G, Owusu D, Smith C, et al. Liver steatosis and fibrosis in people with human immunodeficiency virus in West Africa and the relationship with hepatitis B virus coinfection[J]. Hepatol Commun, 2022, 6(11): 3036-3051.
[20] Wu H, Sang S, Weng P, et al. Structural, rheological, and gelling characteristics of starch-based materials in context to 3D food printing applications in precision nutrition[J]. Compr Rev Food Sci Food Saf, 2023, 22(6): 4217-4241.