PDF(Pubmed)
Abstract：
Nonalcoholic fatty liver disease (NAFLD) is a global epidemic, affecting more than half of the people living with type 2 diabetes (T2D). The relationship between NAFLD and T2D is bidirectional and the presence of one perpetuates the other, which significantly increases the hepatic as well as extrahepatic complications. Until recently, there was no approved pharmacological treatment for NAFLD/ nonalcoholic steatohepatitits (NASH). However, there is evidence that drugs used for diabetes may have beneficial effects on NAFLD. Insulin sensitizers acting through peroxisome proliferator-activated receptor (PPAR) modulation act on multiple levels of NAFLD pathogenesis. Pioglitazone (PPARγ agonist) and saroglitazar (PPARα/γ agonist) are particularly beneficial and recommended by several authoritative bodies for treating NAFLD in T2D, although data on biopsy-proven NASH are lacking with the latter. Initial data on elafibanor (PPAR α/δ agonist) and Lanifibranor (pan PPAR agonist) are promising. On the other hand, incretin therapies based on glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1RA) and dual- and triple-hormone receptor co-agonists reported impressive weight loss and may have anti-inflammatory and antifibrotic properties. GLP-1 RAs have shown beneficial effects on NAFLD/NASH and more studies on potential direct effects on liver function by dual- and triple-agonists are required. Furthermore, the long-term safety of these therapies in NAFLD needs to be established. Collaborative efforts among healthcare providers such as primary care doctors, hepatologists, and endocrinologists are warranted for selecting patients for the best possible management of NAFLD in T2D.
摘要：
非酒精性脂肪性肝病（NAFLD）是一种全球性的流行病，影响超过一半的2型糖尿病患者（T2D）。NAFLD和T2D之间的关系是双向的，一个的存在延续了另一个，这显著增加了肝和肝外并发症。直到最近,对于NAFLD/非酒精性脂肪性肝炎(NASH),尚无批准的药物治疗.然而,有证据表明,用于糖尿病的药物可能对NAFLD产生有益作用.通过过氧化物酶体增殖物激活受体（PPAR）调节作用的胰岛素增敏剂作用于NAFLD发病机制的多个水平。吡格列酮（PPARγ激动剂）和saroglitazar（PPARα/γ激动剂）特别有益，并被一些权威机构推荐用于治疗T2D中的NAFLD，尽管后者缺乏活检证实的NASH数据。关于elafibanor（PPARα/δ激动剂）和Lanifibanor（panPPAR激动剂）的初步数据是有希望的。另一方面,基于胰高血糖素样肽-1（GLP-1）受体激动剂（GLP-1RA）和双激素和三激素受体共激动剂的肠促胰岛素治疗报告了令人印象深刻的体重减轻，并且可能具有抗炎和抗纤维化特性。GLP-1RAs已显示出对NAFLD/NASH的有益作用，并且需要更多关于双重和三重激动剂对肝功能的潜在直接影响的研究。此外，需要确定这些治疗在NAFLD中的长期安全性.初级保健医生等医疗保健提供者之间的合作努力，肝病学家,和内分泌学家有必要选择患者进行T2D中NAFLD的最佳治疗。
