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Frontiers and prospects of pharmacotherapy for non-alcoholic fatty liver disease

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Author:: No author available

Journal Title:: World Chinese Journal of Digestology

Issue:: 2

DOI:: 10.11569/wcjd.v27.i2.73

Key Word:: 非酒精性脂肪肝;药物治疗;新药开发;作用机制

Abstract：尽管近年来非酒精性脂肪肝(non-alcoholic fatty liver disease,NAFLD)的发病率在不断增加,但是临床上仍缺乏公认的对NAFLD具有明显疗效的药物干预,目前治疗NAFLD的主要方法是改变生活方式,包括减肥和饮食调整.然而,这些治疗方法有时效果不佳,尤其是对于非酒精性脂肪性肝炎(non-alcoholic steatohepatitis,NASH)的患者.针对NAFLD的发病机制,多种药物已被用于治疗NASH的临床试验,部分展示了一定的临床价值.目前,欧美一些指南只推荐作为胰岛素增敏剂的吡格列酮和作为抗氧化剂的维生素E用于治疗NASH.包括他汀类药物和贝特类药物的降脂药、己酮可可碱、血管紧张素受体阻断剂、熊去氧胆酸、益生菌和合生素是目前潜在治疗NASH的有益药物,但来源于小样本量的随机双盲对照临床试验所获得的证据强度尚不足以至得到监管部门的批准.一些新兴的药物正在开发用于治疗NASH,例如奥贝胆酸、利拉鲁肽、elafibranor、cenicriviroc、aramchol、成纤维细胞生长因子(FGF)-21或FGF-19类似物、IMM-124e、奥利司他、solithromycin,simtuzumab和GR-MD-02、remogliflozin etabonate、lipaglyn、SHP626、PXS4728A等已在临床试验中测试或正在完成试验.因此,本文主要针对NAFLD的肝脏脂肪蓄积和由此产生的代谢应激、氧化应激、肠道微生物紊乱、纤维化进程等药物治疗学前沿进展进行综述.

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