運動、飲食與藥品於MAFLD的治療

Exercise, Diet and Medication for the Treatment of MAFLD

非酒精性脂肪肝（Non-alcoholic fatty liver disease, NAFLD），或稱為代謝功能障礙相關的脂肪肝病（metabolic dysfunction-associated steatotic liver disease, MASLD）是一種普遍的肝病，從單純性脂肪變性到非酒精性脂肪性肝炎（non-alcoholic steatohepatitis, NASH），後者會導致纖維化、肝硬化和肝細胞癌。根據統計，NAFLD在全亞洲地區發生率約27.3%。造成的相關死亡原因，包含心血管疾病（25-43%）、非肝的惡性腫瘤（19-28%）、肝臟相關疾病（9-15%）。民眾對於疾病相關的認知較低、缺乏精準的即時診斷法及生物標記、不同的文化背景等，讓診斷及治療增加困難度。而了解NASH和肝纖維化的發病機制對於診斷和治療的發展非常重要。研究顯示，達到7%減重目標的患者，能在NASH組織學上有顯著的改善。針對NAFLD的治療，可從運動及飲食做起，包括每週至少1次的60分鐘運動、熱量控制、適當限制食物選擇；此外，目前有相當多實證的藥物治療，例如semaglutide、pioglitazone、vitamin E、angiotensin II receptor blocker等。目前也有其他藥物治療需進一步的研究，才能有安全且有效的脂肪肝治療。

Non-alcoholic fatty liver disease (NAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent liver disease, comprises a spectrum of hepatic pathologies, ranging from simple steatosis to non-alcoholic steatohepatitis (NASH). It leads to fibrosis, cirrhosis and hepatocellular carcinoma development. The incidence rate of NAFLD in Asia is approximately 27.3%. Relevant causes of death include cardiovascular disease (25-43%), non-hepatic malignancy (19-28%), and liver-related diseases (9-15%). Low awareness of the disease, lack of accurate and immediate diagnostic methods and biomarkers, and different cultural backgrounds make diagnosis and treatment more difficult. Understanding the pathogenesis of NASH and liver fibrosis is very important for the development of diagnosis and treatment. Studies have shown that patients who achieve a 7% weight loss goal can experience significant histological improvement in NASH. Treatment for NAFLD/MASLD can start with exercise and diet, including minimum of 60 minutes of exercise in a week, calorie control, and appropriate restriction of food. In addition, there are some evidence-based medicines for treatment, such as hypolipidemic agents, antidiabetic agents, vitamin E, angiotensin II receptor blockers, resmetiron etc. Furthermore, other drugs in ongoing trials require further study to safely treat the liver disease.