脂肪肝的篩檢、診斷、臨床影響及治療

Screening, Diagnosis, Clinical Implications, and Management of Hepatic Steatosis

近年來，非酒精性脂肪肝病與酒精性肝病持續增加，成為重要的臨床問題。代謝異常脂肪肝病，是取代非酒精性脂肪肝病的新命名，只要脂肪肝再加上一項心臟代謝危險因子：身體質量指數>23 kg/m2、血糖過高、血壓過高、三酸甘油酯過高，或高密度膽固醇過低即可診斷。酒精飲用、特定基因、特定藥物、體重過重及代謝異常會加重脂肪肝。目前有血液、超音波及磁振造影檢查等方式，可以檢測肝纖維化及脂肪肝的程度。臨床上建議利用FIB-4指標來初步評估肝纖維化，嚴重的肝纖維化會加重肝病的不良預後。代謝異常脂肪肝需要針對心臟代謝危險因子、肝脂肪或是肝纖維化來處理。建議先飲食控制及運動減重，改善脂肪肝及肝纖維化。甲狀腺激素受體β選擇性促進劑（resmetirom）及第一型類升糖素胜肽受體促效劑（semaglutide），已經被美國食品及藥物管理局核准，用於患有代謝異常脂肪肝合併中度至重度肝纖維化成人治療，另有多種針對不同機轉治療的藥物正在研發中。將來會朝向疾病預防、高風險族群的篩檢及早期診斷，早期治療的目標努力，以期減少代謝異常脂肪肝在台灣的疾病負擔。

In recent years, both non-alcoholic fatty liver disease (NAFLD) and alcoholic liver disease have been increasing, becoming significant clinical problems. Metabolic dysfunction-associated steatotic liver disease (MASLD) is the new terminology replacing NAFLD. The diagnosis of MASLD requires the presence of fatty liver along with cardiometabolic risk factors, such as a body mass index (BMI) >23 kg/m2, high blood sugar, hypertension, high triglycerides, or low high-density lipoprotein (HDL) cholesterol. Alcohol consumption, specific genetic factors, medications, overweight, and metabolic dysfunction can worsen fatty liver disease. Currently, blood tests, ultrasound, and magnetic resonance imaging (MRI) are available to assess the degree of liver fibrosis and steatosis. Clinically, the FIB-4 index is recommended for evaluating liver fibrosis, as severe fibrosis worsens liver disease prognosis. The management of MASLD should focus on addressing cardiometabolic risk factors, steatosis or liver fibrosis. Lifestyle modifications, including dietary control and weight loss through exercise, are recommended to improve fatty liver and fibrosis. Resmetirom, a selective thyroid hormone receptorβagonist, and semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, have been approved for the treatment of adult patients with moderate to advanced liver fibrosis associated with MASLD. Additionally, multiple drugs targeting different mechanisms are under development. Future efforts will focus on disease prevention, screening high-risk populations, early diagnosis, and timely treatment to reduce the burden of MASLD in Taiwan.