小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 无明显饮酒史
- 肝功能检查轻度异常
- 躯干性肥胖
其他诊断因素
- 乏力和不适感
- 右上腹不适
- 肝脾肿大
- 慢性肝病体征
危险因素
- 肥胖
- 胰岛素抵抗或糖尿病
- 血脂异常
- 高血压
- 代谢综合征
- 体重迅速下降
- 药物治疗
- 全胃肠外营养 (TPN)
- 与肝细胞脂肪变相关的疾病
诊断性检查
首要检查
- 血清天门冬氨酸氨基转移酶 (AST) 和丙氨酸氨基转移酶 (ALT)
- 总胆红素
- 碱性磷酸酶
- γ-谷氨酰转移酶
- 全血细胞计数 (FBC）
- 生化检查
- 血脂
- 凝血酶原时间和 INR
- 血清白蛋白
- 自身免疫性肝病筛查
- 铁检测
- 乙型肝炎表面抗原、表面抗体和核心抗体
- 丙型肝炎病毒抗体
- α-1 抗胰蛋白酶水平和表型
- 肝脏超声
需考虑的检查
- 空腹胰岛素
- 稳态模型评估 (homeostatic model assessment, HOMA) 计算
- 腹部 MRI
- 弹性成像
- 肝脏活检
- 铜蓝蛋白
- HFE 基因突变检测
- 抗 M2 线粒体抗体
新兴检查
- 细胞角蛋白-18片段
治疗流程
无终末期肝病
终末期肝病
撰稿人
作者
Shahid M. Malik, MD
Clinical Assistant Professor of Medicine
Division of Gastroenterology, Hepatology and Nutrition
Department of Medicine
Program Director, Transplant Hepatology Fellowship Program
Starzl Transplantation Institute
University of Pittsburgh Medical Center
Pittsburgh
PA
利益声明
SMM declares that he has no competing interests.
Rachel Zhuang, MD
Physician
General Internal Medicine
University of Pittsburgh Medical Center
Pittsburgh
PA
利益声明
RZ declares that she has no competing interests.
Kapil B. Chopra, MD, FACP, FAASLD, AGAF
Professor of Medicine
Medical Director of Comprehensive Liver Program and Liver Pancreas Institute
University of Pittsburgh School of Medicine
University of Pittsburgh Medical Center
Pittsburgh
PA
利益声明
KBC declares that he has no competing interests.
同行评议者
Philip Newsome, PhD, FRCPE
Senior Lecturer in Hepatology & Honorary Consultant Physician
Liver Research Group
Institute of Biomedical Research
The Medical School
University of Birmingham
Birmingham
UK
利益声明
PN declares that he has no competing interests.
Stephen A. Harrison, MD, LTC, MC
Chief of Hepatology
Department of Medicine
Gastroenterology & Hepatology Service
Brooke Army Medical Center
Fort Sam Houston
Associate Professor of Medicine
University of Texas Health Science Center
Houston
TX
利益声明
SAH is an author of a reference cited in this topic.
Robert D. Goldin, MBCHB, MD, FRCPath
Reader in Liver and GI Pathology
Imperial College at St. Mary's
London
UK
利益声明
RDG declares that he has no competing interests.
鉴别诊断
- 酒精性肝病
- 隐源性肝硬化
- 自身免疫性肝炎
更多 鉴别诊断指南
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- 针对非酒精性脂肪性肝病管理的 EASL-EASD-EASO 临床实践指南
更多 指南医学计算器
MELDNa 评分（用于肝移植等待名单，不适用于 12 岁以下的患者）（SI 单位制）
更多 医学计算器
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