(NAFLD):


&

: %
.
() -
5%

: , ,
A

& )
(, , , ,
)
Paschos P. et al. Hippokratia 2009; 13: 9-19
Hbscher SG.Histopathology 2006; 49: 450-465
Kleiner DE et al. Hepatology 2005; 41: 1313-1321



M
HCV-

X
O
M/ ,

Wilson

, Weber-Christian

, , -HIV, .


60 Thaler H.
Thaler H. et al. Dtsch Med Wochenschr 1962; 87: 1049-1055
Thaler H. et al. Virchows Arch Pathol Anat Physiol Klin Med 1962; 335: 180-210

1980 Ludwig J et al.

Ludwig J. et al. Mayo Clinic Proc 1980; 55:434-438

NAFLD:
>5%


,
.

.
: 2/d (140gr /w)
: 1/d (70gr /w)
Farrell GC. et al. Hepatology 2006; 43: S99-S112


,
NAFLD
.. , 10 -24%
( )

:
,
( , US, CT, MRI, )
Fraser A, et al. NHANES 1999-2004. Gastroenterology 2007, 133:18141820

2040%
Chitturi S. et al. J Gastroenterol Hepatol 2007, 22:778787

30->90%

10-75% 2

20-92%
Angulo P.N Engl J Med 2002;346:1221-1231

BMI30 ( ) P x4.6 NAFLD

: >60%
& >90%
Bellentani S. et al. Ann Intern Med 2000;132:112-117
Aly FZ. Et al.
Adv
Anat Pathol
2011;18:294300
Exp
Diabetes
Res. 2012;2012:404632

BMI 2 P NAFLD

Annals of Hepatology 2009;8:S4-S8

 ()

Am J Clin Nutr 2007;86:285300

FFA - -IR -

IR

Boden G et al. Diabetes 2005;54:3458-3465

 ()

Am J Clin Nutr 2007;86:285300

 vs.

,
FFA, Tg

,
,
,
vs SF ()
TNF-a, IL-6, (P)-Ser . IR
MCP-1 , Tg

Journal of Gastroenterology and Hepatology 2010;25:672-690

Journal of Gastroenterology and Hepatology 2010;25:672-690

Genome-Wide Association Studies (GWAS)

Journal of Gastroenterology and Hepatology 2010;25:672-690

Tg > 200mg/dL x3 P NAFLD vs

HDL< 35mg/dL x2 P NAFLD vs
Clark JM et al. Gastroenterology 2002; 122; 1649-1657

Tg > 500mg/dL Tg 250-500mg/dL & LDL>130mg/dL x5-6 P

Assy N et al. Dig Dis Sci 2000; 45: 1929-1934

, , IR
Daltro C et al.Obes Surg. 2010;20:1536-143

PCOS -
Semin Liver Dis 2008, 28:370379
J Hepatol 2007, 47:412417

Liver Int. 2009;29:113-119

NAFLD - MS
+

, , FFA , IR

IR , (Tg,
HDL), , IR +
IR-

NASH
IR-

: (+) 2
& / NAFLD

adipo-IR FFA x []
Lomonaco R Hepatology Epub ahead of print

NAFLD: Tg + FFA , OGTT

p<0.0001 vs all groups
* p<0.01 to <0.05 vs lean and obese controls
p<0.05 vs obese controls
p<0.01 to <0.05 vs Q1 &Q2.

Lomonaco R Hepatology Epub ahead of print

NAFLD:
*p<0.01 vs lean and obese controls
p<0.01 to <0.05 vs Q1 &Q2

Lomonaco R Hepatology Epub ahead of print


* p<0.01 to <0.05 vs lean & obese controls
p<0.01 vs obese controls
p<0.01 vs Q1 &Q2
p<0.05 vs Q3.

Lomonaco R Hepatology Epub ahead of print

* p<0.01 to <0.05 vs lean and obese controls

p<0.001 vs Q1 & Q2
p<0.05 vs Q4;

Hepatic (HIRi = endogenous glucose production [EGP] x FPI)

Lomonaco R Hepatology Epub ahead of print

NAFLD
10% fast-food, x2.5 4w
NAFLD: . .,

rs738409 SNP
Nat Genet 2008;40:14615.

5-10% 2+40-80%
Diabetes 2003;52(3):7017.
Diabetes Care 2006;29(6):133744.

IR NAFLD
Digestive and Liver Disease 2010;42:320330

NAFLD <> MS

MS 2637% >x3 ..
MS NAFLD > control

NAFLD
56-63% >3x ..
(18%)

NAFLD

Non- NAFLD

437

1957

IDF

161 (36.84%)

105 (5.37%)

NCEP/ATP III

114 (26.09%)

89 (4.55%)

NAFLD MS > control

Journal of Digestive Diseases 2011; 12; 125130

NAFLD MS, DM
NAFLD : ALT (>40 IU/l),
Follow up 11ys , DM, MS.

DM

MS

NAFLD -DM

Non- NAFLD - DM

20/106, 18.9%

15/246, 6.1%;

<0.001

NAFLD -MS

Non- NAFLD - MS

27/81, 33.3%

51/226, 22.6%

0.056

WC, A.Y, IR
NAFLD
MS, DM.
NAFLD p DM, MS,

Am J Gastroenterol. 2009;104:861-867

NAFLD MS ?
197 ,

NAFLD (%)

- 2

>2

73

0.0001

:

test

.

IR

ATP +
NAFLD

ATP

73

38

0.0001

81

62

0.035

87

74

0.012

:
test

.

:
test


.
Diabetes Care 31:562568, 2008

Diabetes Care 31:562568, 2008

Diabetes Care 31:562568, 2008

NAFLD
p MS
p DM
p
NAFLD CV &

Exp Diabetes Res. 2012;2012:404632

J Hepatol. 2010;53:11461147

(, )

, ,

AST ALT, AST/ALT< 1

AST/ALT > 2
ALP -GT <
, PT, ()

US: ( >1/3 Cs)
CT: vs. & .
E (-)

()& ()
,, ,Mallory,
/
Hernaez et al. Hepatology 2011;54:1082-1090
Tannapfel A et al. Virchows Arch. 2011;458:511-23
Tanne F, et al. Hepatology
2005, 41:12901296
AJR 2008;190:993-1002
Karcaaltincaba M et al. Eur J Radiol. 2007;61:33-43



FLI (Fatty Liver Index)
Tg, BMI, -GT, WC
BMC Gastroenterol 2006; 6: 339

+ HOMA + IV
Am J Gastroenterol 2007; 102: 19318.

BAAT score
BMI>28, >50, ALT>2xA, Tg>150
Gastroenterology 2000; 118: 1117-1123

Fibro Test
2-, apo-A1, , , -GT
BMC Gastroenterol 2006; 6: 6

BARD score
BMI28, >50, AST/ALT0.8, 2
Gut 2008; 57: 14411447

Yilmaz Y, et al. Eur J Clin Invest 2011 [Epub ahead of print]

Yilmaz Y, et al. Eur J Clin Invest 2011 [Epub ahead of print]

Yilmaz Y, et al. Eur J Clin Invest 2011 [Epub ahead of print]

Yilmaz Y, et al. Eur J Clin Invest 2011 [Epub ahead of print]


: IR - fat, Glu FFA
NAFLD
- MS NAFLD
, NAFLD R ,
MS

NAFLD
,

NAFLD: ,
MS
NAFLD, MS: