单纯性脂肪肝特色慢病管理模式初探
Preliminary Study of the Characteristic Chronic Disease Management Mode of Simple Fatty Liver Disease

目的：非酒精性脂肪肝病(NAFLD)构成了一个领域的公共健康挑战，这一复杂的肝脏疾患可能导致显著的医疗开支、经济负担以及生活品质的减损，其临床表征可从简单的脂肪沉积演变为非酒精性肝炎(NASH)，乃至有进展为肝癌(HCC)的风险。它通常与代谢综合征有关,包括肥胖、2型糖尿病(T2DM)、高血压和高脂血症。伴随社会生活品质的节节攀升，无酒精引起的肝脏脂肪积聚疾慢性病(即非酒精性脂肪肝病NAFLD)患者数量迅猛增长，遍及全球，特别是在中国经济较发达地区及其他收入较高国家里，其发病率仅次于病毒引发的肝炎，居慢性肝疾患榜首，极大地威胁了人们的健康福祉。NAFLD环括的疾患涵盖非酒精性单纯型肝内脂肪沉积病变(NAFL)、非酒精性肝炎(NASH)、肝硬化至肝细胞性癌变(HCC)等多种形态。在这些中，非酒精性单纯型肝脂肪沉积病(NAFL)，即仅有脂肪堆积于至少5%的肝细胞，呈现出大泡脂肪变性主导的状态，可能会轻度伴发不具特征性的炎症。身为NAFLD早期阶段的表现，NAFL通常被视作较轻微的健康问题，若能早期介入治疗，有望实现痊愈。然而，由于NAFLD在初期并不显著展现任何症状或体征，患者常忽视疾病存在，就医率低，从而使得疾病有可能进展恶化，演变为NASH、肝硬化或者是肝细胞癌等更为严峻的病态。尽管NAFLD是一种非常普遍的肝脏疾病，但很少有人关注预防、管理和治NAFLD所需的政策和策略，故探索一种单纯性脂肪肝的慢病管理模式至关重要。
Purpose: Nonalcoholic Fatty Liver Disease (NAFLD) constitutes a field of public health challenges, this complex liver disease may lead to significant medical expenses, economic burden and reduced quality of life, its clinical characterization can evolve from simple fat deposition to nonalcoholic steatohepatitis (NASH), and even progress to the risk of hepatocellular carcinoma (HCC). It is usually associated with metabolic syndrome, including obesity, type 2 diabetes mellitus (T2DM), hypertension and hyperlipidemia. With the rising social quality of life, the number of patients with liver fat accumulation disease caused by non-alcohol (nonalcoholic fatty liver disease NAFLD) has rapidly increased, spreading across the globe, especially in China’s economically developed areas and other higher income countries, its incidence after the virus of hepatitis, the top of chronic liver diseases, a great threat to people’s health and well-being. Diseases encompassed by NAFLD include non-alcoholic simple fatty liver (NAFL), non-alcoholic steatohepatitis (NASH), cirrhosis to hepatocellular carcinoma (HCC), and other various forms. Among these, non-alcoholic simple fatty liver (NAFL), where only fat accumulates in at least 5% of hepatocytes, presents a state dominated by macrovesicular steatosis and may cause mild and uncharacteristic inflammation. As an early stage of NAFLD, NAFL is usually seen as a minor health problem and can recover with early intervention. However, because NAFLD does not significantly show any symptoms or signs in the initial stage, patients often ignore the existence of the disease, resulting in a low rate of seeking medical attention, which makes the disease likely to worsen and evolve into more severe diseases such as NASH, cirrhosis or hepatocellular carcinoma. Although NAFLD is a very common liver disease, few attention has been paid to the policies and strategies needed for the prevention, management and treatment of NAFLD,