非酒精性脂肪性肝病(NAFLD)是西方国家慢性肝病最常见的原因,常与糖尿病、甲状腺功能减退和代谢综合征等合并存在,心血管病是导致这一患者群体残疾和死亡的最重要原因。疑似NAFLD需排除可导致脂肪肝的其他疾病并全面评估代谢紊乱相关并发症。无创伤性检查措施可准确评估进展期肝纤维化,但难以区分自然史截然不同的单纯性脂肪肝与脂肪性肝炎(NASH)。为此,肝活检仍是NAFLD诊断及分型的金标准。持久的减重可有效治疗NASH,但需警惕体重反跳;无肝衰竭或无明显门脉高压的NAFLD可通过减肥手术改善肝组织学病变。现有临床试验主要集中在胰岛素增敏剂,正在实施的内生大麻素受体拮抗剂的临床试验因神经精神反应提前终止。医生应不断提高对NAFLD的认识,不仅关注其肝病问题,同时需要监测和防治心血管危险因素。 Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in western countries. It is often associated with diabetes, hypothyroidism and metabolic syndrome. Cardiovascular disease is the most important cause of disability and death in this group of patients . Suspected NAFLD is required to exclude other diseases that can lead to fatty liver and to fully assess the complications associated with metabolic disorders. Noninvasive screening measures accurately assess advanced liver fibrosis, but it is difficult to distinguish between simple fatty liver and steatohepatitis (NASH), which have distinctly different histories. To this end, liver biopsy is still the gold standard for the diagnosis and classification of NAFLD. Long-lasting weight loss is effective in treating NASH, but caution is needed for weight-bearing rebound; NAFLD without liver failure or without significant portal hypertension can improve liver histology through bariatric surgery. Existing clinical trials are focused on insulin sensitizers, and clinical trials of endocannabinoid receptor antagonists that are currently in progress are terminated early due to neuropsychiatric responses. Doctors should continually raise their awareness of NAFLD not only for their liver problems, but also for the monitoring and prevention of cardiovascular risk factors.