Không cồn bệnh gan nhiễm mỡ (NAFLD) là một điều kiện y tế có thể tiến triển thành bệnh gan giai đoạn cuối với sự phát triển hậu quả của xơ gan và suy gan. Quang phổ của NAFLD rộng, từ sự tích lũy chất béo đơn giản trong các tế bào gan (nhiễm mỡ) không có bằng chứng sinh hóa | MANAGEMENT OF NASH from clinical trials evaluating promising medications are discussed as well as possibilities for the future. Introduction Non-alcoholic fatty liver disease NAFLD is a medical condition that may progress to end-stage liver disease with the consequent development of cirrhosis and liver failure. The spectrum of NAFLD is wide ranging from simple fat accumulation in hepatocytes steatosis without biochemical or histological evidence of inflammation or fibrosis through fat accumulation plus necroinflam-matory activity with or without fibrosis steatohepatitis or NASH to the development of advanced liver fibrosis or cirrhosis cirrhotic stage . All these stages are histologically indistinguishable from those produced by excessive alcohol consumption but occur in patients who deny alcohol abuse. NASH is a histological diagnosis and represents only a stage within the spectrum of NAFLD. NAFLD should be differentiated from steatosis with or without hepatitis resulting from well-known secondary causes of fatty liver as they have distinctly different pathogeneses and outcomes these disorders are listed in Chapter 1 Table and discussed in Chapter 21. The terms NAFLD and NASH are currently reserved for those patients in whom none of the known single causes of fatty liver disease are responsible for the liver condition. Other liver diseases that may present with a component of steatosis such as viral or autoimmune hepatitis and metabolic hereditary liver diseases should be appropriately excluded. These other liver diseases may themselves be associated with steatosis and individuals suffering from these other liver diseases may also have risk factors for NAFLD see Chapter 23 1 . Obesity type 2 non-insulin dependent diabetes mellitus and hypertriglyceridaemia common features of the insulin resistance metabolic syndrome IRS see Chapter 5 are the most common risk factors or coexistent conditions associated with NAFLD NASH. Given the common occurrence and increasing
