代謝功能障礙相關脂肪性肝病

代謝功能障礙相關脂肪性肝病（Metabolic Dysfunction Associated Steatotic Liver Disease，縮寫MASLD），原稱非酒精性脂肪肝病（Non-Alcoholic Fatty Liver Disease，縮寫NAFLD），是指由於肝臟脂肪代謝紊亂導致脂肪堆積於肝臟內的一系列疾病^[1][2]。MASLD的範圍從單純的肝臟脂肪變性到伴有不同程度的纖維化和肝硬化^[2]。

代謝功能障礙相關脂肪性肝病
類型	脂肪肝、疾病
分類和外部資源
醫學專科	胃腸學
ICD-11	DB92
ICD-10	K76.0
ICD-9-CM	571.8
OMIM	613282、​613387、​613387、​613282
DiseasesDB	29786
eMedicine	175472
Orphanet	33271

流行病學

MASLD是歐美最常見的慢性肝病，其患病率迅速向全球蔓延^[3]。這一疾病的高發率與肥胖症、2型糖尿病、胰島素抵抗、血脂異常等代謝紊亂密切相關^[1]。

診斷和分類

2023年，專家建議將NAFLD更名為MASLD，並為其制定了全新的診斷標準^[1]。新定義特別強調體重超標、胰島素抵抗、血脂異常、2型糖尿病和代謝性炎症等因素在脂肪性肝病發病過程中的重要性，並指出干預這些代謝心血管危險因素對於防治肝病及其合併症的重要性^[1]。

MASLD包括多個疾病階段，從單純脂肪變性到非酒精性脂肪性肝炎（Non-Alcoholic Steatohepatitis, NASH），後者不僅有肝內脂肪堆積，還伴隨肝臟腫脹、炎症和肝細胞受損，最終可能導致肝纖維化或肝硬化^[2][4][5][6]。

治療與干預

目前尚無針對MASLD的有效藥物治療，因此生活方式干預成為治療的主要措施^[7]。飲食調控和運動鍛鍊在MASLD的干預中起著重要作用^[8]。

儘管運動對MASLD患者的具體益處機制仍不完全明確，但通過代謝組學方法分析患者的脂肪組織、血漿、尿液和糞便樣本，可以幫助確定不同類型的運動干預（不改變飲食）對人類MASLD相關代謝變化的影響^[9]。

飲食干預不僅涉及調整個別營養元素，還包括改變整體營養成分和比例，旨在改善代謝功能，減少肝臟脂肪堆積和炎症^[10]。

參考文獻

1. 楊睿; 王琳. 生活习惯对非酒精性脂肪肝病的影响. 中國科學：生命科學. 2024, 54 (5): 819–830. doi:10.1360/SSV-2024-0023. CNKI JCXK202405004.
2. Chalasani, Naga; Younossi, Zobair; Lavine, Joel E.; Diehl, Anna Mae; Brunt, Elizabeth M.; Cusi, Kenneth; Charlton, Michael; Sanyal, Arun J. The Diagnosis and Management of Non-alcoholic Fatty Liver Disease: Practice Guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology. 2012-06, 142 (7): 1592–1609. doi:10.1053/j.gastro.2012.04.001.
3. Younossi, Zobair; Anstee, Quentin M.; Marietti, Milena; Hardy, Timothy; Henry, Linda; Eslam, Mohammed; George, Jacob; Bugianesi, Elisabetta. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nature Reviews Gastroenterology & Hepatology. 2018-01, 15 (1): 11–20. doi:10.1038/nrgastro.2017.109.
4. Raza, Sana; Rajak, Sangam; Upadhyay, Aditya; Tewari, Archana; Sinha, Rohit Anthony. Current treatment paradigms and emerging therapies for NAFLD/NASH. Frontiers in Bioscience-Landmark. 2020-10-01, 26 (2): 206–237 [2024-05-27]. ISSN 2768-6701. doi:10.2741/4892. （原始內容存檔於2024-05-27）.
5. Woo Baidal, Jennifer A.; Lavine, Joel E. The intersection of nonalcoholic fatty liver disease and obesity. Science Translational Medicine. 2016-01-27, 8 (323). doi:10.1126/scitranslmed.aad8390.
6. Goldberg, David; Ditah, Ivo C.; Saeian, Kia; Lalehzari, Mona; Aronsohn, Andrew; Gorospe, Emmanuel C.; Charlton, Michael. Changes in the Prevalence of Hepatitis C Virus Infection, Nonalcoholic Steatohepatitis, and Alcoholic Liver Disease Among Patients With Cirrhosis or Liver Failure on the Waitlist for Liver Transplantation. Gastroenterology. 2017-04, 152 (5): 1090–1099.e1. doi:10.1053/j.gastro.2017.01.003.
7. Younossi, Zobair M.; Zelber-Sagi, Shira; Henry, Linda; Gerber, Lynn H. Lifestyle interventions in nonalcoholic fatty liver disease. Nature Reviews Gastroenterology & Hepatology. 2023-11, 20 (11): 708–722. doi:10.1038/s41575-023-00800-4.
8. Romero-Gómez, Manuel; Zelber-Sagi, Shira; Trenell, Michael. Treatment of NAFLD with diet, physical activity and exercise. Journal of Hepatology. 2017-10, 67 (4): 829–846. doi:10.1016/j.jhep.2017.05.016.
9. Babu, Ambrin Farizah; Csader, Susanne; Männistö, Ville; Tauriainen, Milla-Maria; Pentikäinen, Heikki; Savonen, Kai; Klåvus, Anton; Koistinen, Ville; Hanhineva, Kati; Schwab, Ursula. Effects of exercise on NAFLD using non-targeted metabolomics in adipose tissue, plasma, urine, and stool. Scientific Reports. 2022-04-20, 12 (1). doi:10.1038/s41598-022-10481-9.
10. European Association for the Study of the Liver, (EASL); European Association for the Study of Diabetes, (EASD); European Association for the Study of Obesity, (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease.. Journal of hepatology. 2016-06, 64 (6): 1388–402. PMID 27062661. doi:10.1016/j.jhep.2015.11.004.