medigraphic.com

2011, Número 3

<< Anterior Siguiente >>

Rev Fac Med UNAM 2011; 54 (3)


Hígado graso y esteatohepatitis no alcohólica
Conceptos Actuales

Carrillo ER, Muciño BJ

Idioma: Español
Referencias bibliográficas: 73
Paginas: 29-45
Archivo PDF: 448.63 Kb.


RESUMEN

El hígado graso no alcohólico (HGNA) incluye dentro de su presentación evolutiva a la esteatosis hepática, esteatohepatitis no alcohólica (EHNA), cirrosis y hepatocarcinoma. Se relaciona a obesidad, preferentemente abdominal, diabetes mellitus tipo II y síndrome metabólico (SM). En su fisiopatología están involucrados la sobrenutrición, vida sedentaria, factores genéticos y resistencia a la insulina. Su prevalencia es del 17 al 33%. La EHNA se presenta en el 30% de estos casos, de los cuales un 20 a 25% evoluciona a hepatocarcinoma. El HGNA es una de las causas más frecuentes de alteraciones en las pruebas de función hepática en pacientes asintomáticos. En su fase inicial, se caracteriza por malestar abdominal, fatiga, elevación de alanin aminotransferasa (AAT), gamaglutamil transpeptidasa (GGT), hepatomegalia, e hiperecogenicidad hepática en el ultrasonido. No es una enfermedad benigna, ya que el 32% de los enfermos progresan a fibrosis, el 20% a cirrosis y el riesgo de muerte relacionada a disfunción hepática es del 12% a 10 años. Las alternativas terapéuticas están dirigidas a modificar el estilo de vida, la dieta y el empleo de medicamentos, que en conjunto impactan en la fisiopatología de la enfermedad, en especial en la resistencia a la insulina y SM.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Ong JP, Younossi ZM. Epidemiology and Natural History of NAFLD and EHNA. Clin Liver Dis. 2007:11;1-16.

  2. Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC , et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004: 40;1387-1395.

  3. Roldan-Valadez E, Favila R, Martínez-López M, Uribe M, Méndez-Sánchez N. Imaging techniques for assessing hepatic fat content in nonalcoholic fatty liver disease. Ann Hepatol. 2008;7: 204-212

  4. Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS). Third National Health and Nutrition Examination Survey (NHANES III) http://www.cdc.gov/nchs/nhanes/nh3data.htm

  5. Suzuki A, Angulo P, Lymp J, St Sauver J, Muto A, Okada T, et al. Chronological development of elevated aminotransferases in a nonalcoholic population. Hepatology. 2005:41;64-71.

  6. Zhou YJ, Li YY, Nie YQ, Ma JX, Lu LG, Shi SL, et al. revalence of fatty liver disease and its risk factors in the population of South China. World J Gastroenterol. 2007: 13;6419-24.

  7. Karnikowski M, Córdova C, Oliveira RJ, Karnikowski MG, Nóbrega O de T. Non-alcoholic fatty liver disease and metabolic syndrome in Brazilian middle-aged and older adults, Sao Paulo Med J. 2007:125;333-7.

  8. De Lusong MA, Labio E, Daez L, Gloria V. Non-alcoholic fattyliver disease in the Philippines: Comparable with other nations? World J Gastroenterol. 2008:14; 913-7.

  9. Radu C, Grigorescu M, Crisan D, Lupsor M, Constantin D, Dina L. Prevalence and Associated Risk Factors of Non- Alcoholic Fatty Liver Disease in Hospitalized Patients Gastrointestin Liver Dis. 2008:17;255-60.

  10. Alisi A, Manco M, Panera N, Nobili V. Association between type two diabetes and non-alcoholic fatty liver disease in youth Ann Hepatol. 2009;8:S44-S50.

  11. Marceau P, Biron S, Hould FS, Marceau S, Simard S, Thung SN, et al. Liver pathology and the metabolic syndrome X in severe obesity. J Clin Endocrinol Metab. 1999: 84:1513-7.

  12. Assy N, Kaita K, Mymin D, Levy C, Rosser B, Minuk G. Fatty infiltration of liver in hyperlipidemic patients. Dig Dis Sci. 2000;45:1929-34.

  13. Utzschneider KM, Kahn SE.REVIEW: The Role of Insulin Resistance in Nonalcoholic Fatty Liver Disease. J Clin Endocrinol Metab. 2006;91:4753-61.

  14. Seppälä-Lindroos A, Vehkavaara S, Häkkinen AM, Goto T, Westerbacka J, Sovijärvi A, et al. Fat accumulation in the liver is associated with defects in insulin suppression of glucose production andserum free fattyacids independent of obesityin normal men. J Clin Endocrinol Metab. 2002; 87:3023-8.

  15. Musso G, Gambino R, Bo S, Uberti B, Biroli G, Pagano G, et al. Should nonalcoholic fatty liver disease be included in the definition of metabolic syndrome? A cross-sectional comparison with Adult Treatment Panel III criteria in nonobese nondiabetic subjects. Diabetes Care. 2008;31:562-8.

  16. Edmison J, McCullough AJ. Pathogenesis of Non-alcoholic Steatohepatitis: Human Data. Clin Liver is. 2007;11: 75-104.

  17. Serin E, Ozer B, Gümürdülü Y, Kayaselçuk F, Kul K, Boyacioğlu S. Serum leptin level can be a negative marker of hepatocyte damage in nonalcoholic fatty liver. J Gastroenterol. 2003;38:471-6.

  18. Angulo P, Alba LM, Petrovic LM, Adams LA, Lindor KD, Jensen MD. Leptin, insulin resistance, and liver fibrosis in human nonalcoholic fatty liver disease. J Hepatol. 2004; 41:943-9.

  19. Huang XD, Fan Y, Zhang H, Wang P, Yuan JP, Li MJ, et al. Serum leptin and soluble leptin receptor in non-alcoholic fatty liver disease. World J Gastroenterol. 2008;14:2888-93.

  20. 20. Xu A, Wang Y, Keshaw H, Xu LY, Lam KS, Cooper GJ.The fat-derived hormone adiponectin alleviates alcoholic and nonalcoholic fatty liver diseases in mice. J Clin Invest. 2003; 112:91-100.

  21. Pagano C, Soardo G, Esposito W, Fallo F, Basan L, Donnini D, et al. Plasma adiponectin is decreased in nonalcoholic fatty liver disease. Eur J Endocrinol. 2005;152:113-8.

  22. 22.Crespo J, Cayón A, Fernández-Gil P, Hernández-Guerra M, Mayorga M, Domínguez-Díez A, et al. Gene expression of tumor necrosis factor alpha and TNFreceptors, p55 and p75 in nonalcoholic steatohepatitis patients. Hepatology. 2001;34:1158-63.

  23. Hui JM, Hodge A, Farrell GC, Kench JG, Kriketos A, George J. Beyond insulin resistance in EHNA: TNF-alpha or adiponectin? Hepatology. 2004;40:46-54.

  24. 24.Muse ED, Obici S, Bhanot S, Monia BP, McKay RA, Rajala MW, et al. Role of resistin in diet-induced hepatic insulin resistance. J Clin Invest. 2004;114:232-239.

  25. Qatanani M, Szwergold NR, Greaves DR, Ahima RS, Lazar MA. Macrophage-derived human resistin exacerbates adipose tissue inflammation and insulin resistance in mice. J Clin Invest. 2009:37273.

  26. Pagano C, Soardo G, Pilon C, Milocco C, Basan L, Milan G, et al. Increased serum resistin in nonalcoholic fatty liver disease is related to liver disease severity and not to insulin resistance. J Clin Endocrinol Metab. 2006;3:1081-6.

  27. Brudevold R, Hole T, Hammerstrøm J. Hyperferritinemia is associated with insulin resistance and fatty liver in patients without iron overload. PLoS ONE. 2008;3:e3547.

  28. Aigner E, Theurl I, Theurl M, Lederer D, Haufe H, Dietze O, et. al. Pathways underlying iron accumulation in human nonalcoholic fatty liver disease. Am J Clin Nutr. 2008; 87:1374-1383.

  29. Tellez-Avila FI, Sanchez-Avila F, García-Saenz-de-Sicilia M, Chavez-Tapia NC, Franco-Guzman AM, Lopez-Arce G, et al. Prevalence of metabolic syndrome,obesity and diabetes type 2 in cryptogenic cirrhosis. World J Gastroenterol. 2008:14;4771-5.

  30. Ratziu V, Bonyhay L, Di Martino V, Charlotte F, Cavallaro L, Sayegh-Tainturier MH, et al. Survival, liver failure, and hepatocellular carcinoma in obesity-related cryptogenic cirrhosis. Hepatology. 2002;35:1485-93.

  31. Bugianesi E, Leone N, Vanni E, Marchesini G, Brunello F, Carucci P, et al. Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma. Gastroenterology. 2002;1231:134-40.

  32. 32.Hashimoto E, Yatsuji S, Tobari M, Taniai M, Torii N, Tokushige K, et al. Hepatocellular carcinoma in patients with nonalcoholic steatohepatitis. J Gastroenterol. 2009; 44:89-95.

  33. Farrell GC, Larter CZ. Nonalcoholic fatty liver disease: from steatosis to cirrhosis. Hepatology. 2006;43:S99-S112.

  34. Adams LA, Lymp JF, St Sauver J, Sanderson SO, Lindor KD, Feldstein A, et al. The natural history of nonalcoholic fatty liver disease: a population-based cohort study. Gastroenterology. 2005 Jul;129:113-21.

  35. Fracanzani AL, Burdick L, Raselli S, Pedotti P, Grigore L, Santorelli G, et al. Carotid Artery Intima-media Thickness in Nonalcoholic Fatty Liver Disease. Am J Med. 2008;121:72-8.

  36. 36.Hamaguchi M, Kojima T, Takeda N, Nagata C, Takeda J, Sarui H, et al. Nonalcoholic fatty liver disease is a novel predictor of cardiovascular disease. World J Gastroenterol. 2007;13: 1579-84.

  37. Ratziu V, Charlotte F, Heurtier A, Gombert S, Giral P, Bruckert E, et al. Sampling variability of liver biopsy in nonalcoholic fatty liver disease Gastroenterology. 2005;128:1898-906.

  38. Uslusoy HS, Nak SG, Gülten M, Biyikli Z. Non-alcoholic steatohepatitis with normal aminotransferase values. World J Gastroenterol. 2009;15:1863-8.

  39. Grattagliano I, Portincasa P, Palmieri VO, Palasciano G. Managing nonalcoholic fatty liver disease: Recommendations for family physicians Can Fam Physician. 2007;53:857-63.

  40. Adams L, Angulo P, Lindor K. Nonalcoholic fatty liver disease. CMAJ. 2005;172:899-905.

  41. De Lédinghen V, Vergniol J.Transient elastography (FibroScan). Gastroenterol Clin Biol. 2008;32:58-67.

  42. Jung MK, Cho HJ, Lee HC, Park KS, Seo EH, Jeon SW, et al. Comparison of transient elastography and hepatic fibrosis assessed by histology in chronic liver disease] Korean J Gastroenterol. 2008;51:241-7.

  43. Foucher J, Chanteloup E, Vergniol J, Castéra L, Le Bail B, Adhoute X, et al. Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study. Gut. 2006;55: 403-8.

  44. Li LF, Dai L, Zhang Q, Chen YP, Feng XR, Guo YB, et al. Factors influencing the success rate and stability of transient elastography for liver fibrosis evaluation. Nan Fang Yi Ke Da Xue Xue Bao. 2008;28:595-597.

  45. Ratziu V, Massard J, Charlotte F, Messous D, Imbert- Bismut F, Bonyhay L, et al. Diagnostic value of biochemical markers (FibroTest-FibroSURE) for the prediction of liver fibrosis in patients with non-alcoholic fatty liver disease. BMC Gastroenterol. 2006; 14:6:6.

  46. Poynard T, Ratziu V, Charlotte F, Messous D, Munteanu M, Imbert-Bismut F, et al. Diagnostic value of biochemical markers (EHNATest) for the prediction of non alcoholo steato hepatitis in patients with non-alcoholic fatty liver disease. BMC Gastroenterol. 2006;10:34.

  47. Gressner AM, Gao CF, Gressner OA. Non-invasive biomarkers for monitoring the fibrogenic process in liver: a short survey World J Gastroenterol. 2009;15:2433-40.

  48. 48.Myers R. Noninvasive diagnosis of nonalcoholic fatty liver disease. Ann Hepatol. 2009;8:S25-S33.

  49. Adams LA, Angulo P. Role of liver biopsy and serum markers of liver fibrosis in non-alcoholic fatty liver disease. Clin Liver Dis. 2007;11:25-35.

  50. Sebastiani G. Non-invasive assessment of liver fibrosis in chronic liver diseases: implementation in clinical practice and decisional algorithms. World J Gastroenterol. 2009; 14:2190-203.

  51. Bondini S, Kleiner DE, Goodman ZD, Gramlich T, Younossi ZM. Pathologic Assessment of Non-alcoholic Fatty Liver Disease Clin Liver Dis. 2007;11:17-23.

  52. Susuki A, Lindor K, St Saber J, Lymp J, Mendes F, Muto A, et al. Effect of changes on body weight and lifestyle in nonalcoholic fatty liver disease. J Hepatol. 2005;43:1060-6.

  53. Gill HK, Wu GY. Non-alcoholic fatty liver disease and the metabolic syndrome: Effects of weight loss and a review of popular diets. Are low carbohydrate diets the answer? World J Gastroenterol. 2006;12:345-53.

  54. Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008 Jul 17;359:229-241.

  55. Aude YW, Agatston AS, Lopez-Jimenez F, Lieberman EH, Marie Almon, Hansen M, et al. The national cholesterol education program diet vs a diet lower in carbohydrates and higher in protein and monounsaturated fat: a randomized trial. Arch Intern Med. 2004;164:2141-6.

  56. Ryan MC, Abbasi F, Lamendola C, Carter S, McLaughlin TL. Serum alanine aminotransferase levels decrease further with carbohydrate than fat restriction in insulin-resistant adults. Diabetes Care. 2007 May;30:1075-80.

  57. Caldwell S, Lazo M. Is exercise an effective treatment for EHNA? Knowns and unknowns. Ann Hepatol. 2009;8: S60-S66

  58. Chen SM, Liu CY, Li SR, Huang HT, Tsai CY, Jou HJ. Effects of therapeutic lifestyle program on ultrasound-diagnosed nonalcoholic fatty liver disease. J Chin Med Assoc. 2008;71:551-558.

  59. Harrison SA, Fincke C, Helinski D, Torgerson S, Hayashi P. A pilot study of orlistat treatment in obese, non-alcoholic steatohepatitis patients. Aliment Pharmacol Ther. 2004; 20:623-628.

  60. Lam P, Younossi Z. Treatment regimens for non-alcoholic fatty liver disease. Ann Hepatol 2009;8:S51-S59.

  61. Tolman K, Dalpiaz A. Treatment of non-alcoholic fatty liver disease. Therapeutics and Clinical Risk Management. 2007;3:1153-62.

  62. Sabuncu T, Nazligul Y, Karaoglanoglu M, Ucar E, Kilic FB. The effects of sibutramine and orlistat on the ultrasonographic findings, insulin resistance and liver enzyme levels in obese patients with non-alcoholic steatohepatitis. Rom J Gastroenterol. 2003;12: 189-92.

  63. Dixon JB. Surgical Treatment for Obesity and Its Impact on Non-alcoholic Steatohepatitis. Liver Dis. 2007;11:141-54.

  64. Furuya CK Jr, de Oliveira CP, de Mello ES, Faintuch J, Raskovski A, Matsuda M, et al. Efects of bariatric surgery on nonalcoholic fatty liver disease: preliminary findings after 2 years. J Gastroenterol Hepatol. 2007;22:510-4.

  65. De Andrade AR, Cotrim HP, Alves E, Soares D, Rocha R, Almeida A. Nonalcoholic fatty liver disease in severely obese individuals: the influence of bariatric surgery. Ann Hepatol. 2008;7:364-8.

  66. Khashab M, Chalasani N. Use Of Insulin Sensitizers In EHNA Endocrinol Metab Clin N Am 2007; 36: 1067-1087.

  67. Georgescu EF, Georgescu M Therapeutic options in nonalcoholic steatohepatitis (EHNA). Are all agents alike? Results of a preliminary study. J Gastrointestin Liver Dis. 2007; 16: 39-46

  68. Rockey DC. Current and Future Anti -Fibrotic Therapies for Chronic Liver Disease Clin Liver Dis 2008; 12: 939-962

  69. Loguercio C, Federico A, Tuccillo C, Terracciano F, D’Auria MV, De Simone C, et al. Beneficial effects of a probiotic VSL#3 on parameters of liver dysfunction in chronic liver diseases. J Clin Gastroenterol. 2005; 39: 540-553.

  70. Li Z, Yang S, Lin H, Huang J, Watkins PA, Moser AB. et al Probiotics and antibodies to TNF inhibit inflammatory activity and improve nonalcoholic fatty liver disease. Hepatology. 2003;37:343-50

  71. Yokohama S, Tokusashi Y, Nakamura K, Tamaki Y, Okamoto S, Okada M, et al. Inhibitory effect of angiotensin II receptor antagonist on hepatic stellate cell activation in non-alcoholic steatohepatitis. World J Gastroenterol. 2006; 12:322-6.

  72. Zhang KY, Tung BY, Kowdley KV. Liver Transplantation for Metabolic Liver Diseases. Clin Liver Dis. 2007;11:265-28.

  73. Feldman: Sleisenger & Fordtran’s Gastrointestinal and Liver Disease, 8a. ed., Saunders, 2006




2020     |     www.medigraphic.com