编者按：在今年的中华医学会肝病学分会学术年会期间，脂肪肝和酒精性肝病学组邀请了来自友好邻邦巴基斯坦的专家--Shifa国际医院消化内科Muzaffar Gill教授分享巴基斯坦在非酒精性脂肪性肝病（NAFLD）的研究和诊疗方面的经验。Gill教授在接受《国际肝病》记者采访时，对报告精华进行了总结，内容如下。

 

据Gill教授介绍，巴基斯坦约有2.2亿人，其中四分之一患有非酒精性脂肪性肝病（NAFLD），这意味着近5000万巴基斯坦人存在肝内脂肪过多堆积的问题。在罹患NAFLD的人群中，约10%的患者进展为非酒精性脂肪性肝炎（NASH）且有较严重的临床表现。Gill教授认为，这与巴基斯坦人群中的肥胖、高血压和糖尿病流行率较高有关。

 

在巴基斯坦，诊断NAFLD的方法是对高危代谢性疾病患者进行筛查。这些患者多为≥40岁的、罹患糖尿病或高血压的男性，通常以非特异性症状就诊，在腹部超声检查时偶然发现肝脏脂肪沉积，也有患者因上腹部疼痛就诊时经超声检查确诊NAFLD。

 

丙型肝炎已经能够获得很好的控制，NAFLD正成为我们面临的新挑战。NAFLD是一个全球性问题，在印度次大陆（如巴基斯坦），以及中国更为突出。Gill教授认为，预防是控制NAFLD的首要措施，即鼓励人们健康生活、健康饮食和积极锻炼。如果患者已处于疾病进展期，可以给予药物治疗，奥贝胆酸是其中一个选择。许多临床试验表明，奥贝胆酸有助于去除肝脏中的脂肪，阻止纤维化进展，进一步阻止肝硬化形成。

 

英文采访原文：

 

The population of Pakistan is 220 million. One quarter of the population suffers from non-alcoholic fatty liver disease, which means close to 50 million Pakistanis have high deposits of fat in their liver. Among those who are suffering from NAFLD, 10% have serious consequences of the condition in the form of non-alcoholic steatohepatitis. This is due to the prevalence of obesity, high blood pressure and sugar in our population. 

 

The way to diagnose non-alcoholic fatty liver disease is to screen the high-risk metabolic patients. These are men, aged 40 and over, diabetic, and hypertensive, and will usually be showing very non-specific symptoms. It can be an incidental finding on an abdominal ultrasound where fat deposits are visible, an increased echogenicity of the liver. Sometimes patients present with upper abdominal pain, which leads to these ultrasound findings. 

 

Now that hepatitis C treatment is under control, we are facing a new challenge. That challenge is non-alcoholic fatty liver disease all over the world, but moreso on the Indian subcontinent, in Pakistan and China. Prevention is the first goal - healthy lifestyle, healthy food, and exercise. If patients have advanced disease, there are a couple of drugs that can be applied. One is obeticholic acid, and many trials have shown that this drug helps remove fat from the liver, and arrest the progression of fibrosis and then liver cirrhosis.