medicina54巻7号

2017年06月発行

特集 外来診療必読エビデンス—日米比較で考える内科Standards of Excellence 各論

日本編　NAFLD

著者： 中島淳¹ 今城健人¹ 米田正人¹

所属機関： ¹横浜市立大学肝胆膵消化器病学教室

ページ範囲：P.1094 - P.1099

Point
◎NAFLDは，有病率が世界人口の2〜3割という膨大な患者数がいることがメタ解析から示された，最も患者数の多い肝臓疾患である．
◎NAFLDにおける最多の死亡原因は心血管イベントであるが，肝関連死を含め，NAFLDの予後を決めるのは肝臓の線維化の有無である．
◎NAFLDの診断では，肝生検に代わり，脂肪化や線維化の程度をエラストグラフィで非侵襲的に定量できるようになった．
◎現在保険適用を得たNAFLD（NASH）治療薬は国内外ともにないが，多数の新薬治験が精力的に行われている．

参考文献

1）日本消化器病学会（編）：NAFLD/NASH診療ガイドライン2014，南江堂，2014

2）Younossi ZM, et al：Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 64：73-84, 2016

3）Angulo P, et al：Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology 149：389-397, 2015

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5）Imajo K, et al：Magnetic resonance imaging more accurately classifies steatosis and fibrosis in patients with nonalcoholic fatty liver disease than transient elastography. Gastroenterology 150：626-637, 2016

6）Vilar-Gomez E, et al：Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology 149：367-378, 2015

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9）Nakade Y, et al：Ezetimibe for the treatment of non-alcoholic fatty liver disease；A meta-analysis. Hepatol Res（doi：10.1111/hepr. 12887）［Equb ahead of print］

10）Chalasani NP, et al：Pioglitazone versus vitamin E versus placebo for the treatment of non-diabetic patients with non-alcoholic steatohepatitis；PIVENS trial design. Contemp Clin Trials 30：88-96, 2009

11）Sanyal AJ, et al：No significant effects of ethyl-eicosapentanoic acid on histologic features of nonalcoholic steatohepatitis in a phase 2 trial. Gastroenterology 147：377-384, 2014

12）Neuschwander-Tetri BA, et al：Farnesoid X nuclear receptor ligand obeticholic acid for non-cirrhotic, non-alcoholic steatohepatitis（FLINT）；A multicentre, randomised, placebo-controlled trial. Lancet 385：956-965, 2015

13）Ratziu V, et al：Elafibranor, an agonist of the peroxisome proliferator-activated receptor-α and-δ, induces resolution of nonalcoholic steatohepatitis without fibrosis worsening. Gastroenterology 150：1147-1159, 2016

14）Armstrong MJ, et al：Liraglutide safety and efficacy in patients with non-alcoholic steatohepatitis（LEAN）；A multicentre, double-blind, randomised, placebo-controlled phase 2 study. Lancet 387：679-690, 2016