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Fatty liver has become the most common chronic liver disease in the world. The prevalence of fatty liver in adults in China has exceeded 25%, and one in every 3 adults in Beijing and Shanghai has fatty liver. When B-ultrasound diagnoses fatty liver, do you need medication? What medicine can I take?

 

I. Simple fatty liver: the risk of progression to cirrhosis is small

Fatty liver includes: alcoholic fatty liver and nonalcoholic fatty liver. The fatty liver mentioned in this article refers specifically to nonalcoholic fatty liver disease (NAFLD).

Nonalcoholic fatty liver disease (NAFLD) = simple hepatic steatosis (NAFL) + steatohepatitis (NASH)

The incidence of cirrhosis in patients with simple hepatic steatosis was only 0.6% to 3.0% after 10 to 20 years of follow-up, while the incidence of cirrhosis in patients with steatohepatitis was as high as 15% to 25% within 10 to 15 years.

 

II. Can simple fatty liver be reversed?

Yes, weight loss is the last word!

According to the study: to improve liver fat, at least 3% to 5% weight loss; improve liver histopathology (inflammation, hepatocyte ballooning, fibrosis), you need to lose 7% to 10%.

Weekly exercise ≥ 150 minutes is beneficial for the reduction of serum transaminase levels.

 

III. Vitamin E: effective in treating steatohepatitis

Oxidative stress is a key mechanism of steatohepatitis.

Vitamin E (alpha-tocopherol) has a phenolic hydroxyl group and is an antioxidant. 1 mg of vitamin E = 1.67 U of vitamin E.

Foreign clinical trials have shown that vitamin E (800 IU / day) for 2 years, can reduce the level of transaminase in non-diabetic patients with fatty hepatitis, and can improve liver steatosis, inflammation and balloon-like changes, but not effective for liver fibrosis.

Long-term oral administration of vitamin E can cause blurred vision, breast enlargement, headache, nausea, diarrhea, and affect sexual function, and there is a risk of thrombophlebitis or embolism.

IV. Metformin: The effect is extremely limited!

Nonalcoholic fatty liver disease (NAFLD) is a metabolic stress liver injury closely related to insulin resistance (IR).

Metformin improves insulin resistance and improves serum aminotransferase abnormalities. However, metformin does not improve liver histopathological changes in patients with nonalcoholic fatty liver disease.

Therefore, metformin is not recommended for the treatment of adult fatty hepatitis, but it can be used for the prevention and treatment of type 2 diabetes in patients with nonalcoholic fatty liver.

V. Pioglitazone: can reduce liver cell damage and fibrosis

Rosiglitazone and pioglitazone, both of which are thiazolidinedione insulin sensitizers, increase the sensitivity of liver, muscle and adipose tissue to insulin.

Although they belong to the same class of drugs, the structure of the drugs is different, and the pharmacological effects are also different.

Rosiglitazone improves hepatic steatosis and does not improve inflammation and fibrosis. Treatment with pioglitazone (30 mg/day) for 12 months can reduce hepatocyte damage and fibrosis.

However, pioglitazone can cause an increase in blood volume, with a mild to moderate edema rate of 4.8%, which can even cause or aggravate congestive heart failure.

It is recommended that pioglitazone be used only for the treatment of patients with steatohepatitis in patients with type 2 diabetes.

VI. Liraglutide: Prevents progression of fibrosis!

Liraglutide is a GLP-1 analog that promotes glucose concentration-dependent secretion of insulin in pancreatic beta cells.

Liraglutide not only lowers blood sugar, but also reduces body weight and improves insulin resistance. Liraglutide (1.8 mg/day, subcutaneous injection) for 1 year can significantly improve steatohepatitis and prevent progression of fibrosis.

Liraglutide is suitable for the treatment of obese patients with type 2 diabetes.

 

VII. Hepatoprotective drugs: to be confirmed by further clinical research!

Studies have shown that curcumin, silymarin can be used for the treatment of nonalcoholic fatty liver, which can reduce transaminase (ALT, AST) and body mass index (BMI).

However, to date, there are no recognized hepatoprotective drugs that can be recommended for routine treatment of nonalcoholic steatohepatitis (NASH).

 

Special reminder:

For non-alcoholic fatty liver disease, especially in patients with fatty hepatitis, avoid using Chinese and Western medicines that may have hepatotoxicity, use health care products with caution, and avoid extremely low calorie diet to lose weight.

Statins do not increase the risk of severe liver damage in patients with nonalcoholic fatty liver disease, and therefore can be used for the treatment of dyslipidemia in patients with nonalcoholic fatty liver disease.

Drinking more coffee and tea may help patients with nonalcoholic fatty liver disease recover.

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