非酒精性脂肪肝病之肝外系統疾病

Extra-Hepatic Manifestations of Non-Alcoholic Fatty Liver Disease

非酒精脂肪肝病患者常伴隨有代謝異常的問題，因此臨床上常見到患者，會同時伴隨有許多代謝異常有關的肝外系統疾病，包括肥胖症、糖尿病、血脂異常、代謝症候群、心血管疾病、慢性腎臟疾病、癌症、多囊性卵巢症候群、甲狀腺機能低下症、阻塞型睡眠呼吸中止症、骨質疏鬆症、肌少症與乾癬等。臨床證據顯示，肝外系統疾病與非酒精性脂肪肝病不但臨床關係密切，並且會互相影響，部分肝外系統疾病，甚至可能影響非酒精性脂肪肝病患者的預後以及死亡。所以臨床上面對非酒精性脂肪肝病患者時，除了治療肝臟疾病本身以外，還需要同特處理這些肝外系統疾病對病人可能造成的各種風險及傷害，包括給予患者一般常規建議的體重控制、調整及改變飲食與運動習慣，以及針對各種肝外系統疾病的評估與處置。因此結合各種肝外系統疾病的評估與治療，將成為非酒精性脂肪肝病患者，臨床醫療照護上的重要核心，使治療照護變得更全面性、更深入性、更個人化以及更精準化。本文將針對目前臨床上較重要、常見，並且已累積有較多臨床實證支持著，與非酒精性脂肪肝病關聯的肝外系統疾病，做簡單的介紹與說明。

Patients with non-alcoholic fatty liver diseases are often accompanied by metabolic abnormalities and various extrahepatic systemic diseases, including obesity, diabetes, dyslipidemia, metabolic syndrome, cardiovascular diseases, chronic kidney diseases, cancers, polycystic ovary syndrome, hypothyroidism, obstructive sleep apnea, osteoporosis, sarcopenia, and psoriasis. Current evidence shows that extrahepatic systemic diseases and non-alcoholic fatty liver disease are not only closely related clinically but also interact with each other. Some extrahepatic systemic diseases may affect the clinical prognosis, outcomes, and death of patients with non-alcoholic fatty liver diseases. Therefore, When managing patients with non-alcoholic fatty liver diseases, we need to manage the liver disease per se and the associated various injuries and risks accompanying extrahepatic system diseases. In addition to the general recommendations for body weight control, and the adjustment for diet and exercise habits, the assessment and treatment of various extrahepatic systemic diseases will become an important part of the standard of care for patients with nonalcoholic fatty liver diseases. Combining the evaluation and treatment of various extrahepatic systemic diseases not only will improve the quality of treatment and care for patients with non-alcoholic fatty liver diseases, but also make the management more comprehensive, in-depth, personalized, and precise. In this article, I will briefly introduce some clinically common and important extrahepatic systemic diseases that are frequently associated with non-alcoholic fatty liver diseases.