肝脏脂肪样变性

最后审阅: 1 九月 2022
最后更新: 10 八月 2022

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
更多 关键诊断因素

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
其他诊断因素

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
更多 危险因素

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
更多 首要检查

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
更多 需考虑的检查

新兴检查

  • 细胞角蛋白-18片段

治疗流程

持续性治疗

无终末期肝病

终末期肝病

撰稿人

作者

Shahid M. Malik, MD
Shahid M. Malik

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
Kapil B. Chopra

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.

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