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Nichtalkoholische Fettlebererkrankung

Hepatische Manifestation des metabolischen Syndroms

Nonalcoholic fatty liver disease

Hepatic manifestations of metabolic syndrome

  • Schwerpunkt: Systemische Manifestationen von Organerkrankungen
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Zusammenfassung

Die nichtalkoholische Fettlebererkrankung („nonalcoholic fatty liver disease“, NAFLD) ist heute weltweit die Hauptursache für chronische Lebererkrankungen und zeigt eine starke Assoziation zum metabolischen Syndrom. Die NAFLD ist eine systemische Erkrankung und mit einer Fülle von extrahepatischen Manifestationen und Komorbiditäten verbunden, wie Typ-2-Diabetes, Adipositas und Fettstoffwechselstörungen. Diese extrahepatischen Erkrankungen stehen entweder im Zusammenhang mit sekundären Effekten der assoziierten Adipositas oder mit pathophysiologischen Effekten der Insulinresistenz bei NAFLD. Die 3 häufigsten Ursachen für die beobachtete erhöhte Morbidität und Mortalität im Zusammenhang mit NAFLD sind Herz-Kreislauf-Erkrankungen, Lebererkrankungen wie z. B. die Leberzirrhose und Krebserkrankungen. In der vorliegenden Übersicht werden Herz-Kreislauf-Erkrankungen, Typ-2-Diabetes mellitus und chronische Nierenerkrankungen im Zusammenhang mit der NAFLD beispielhaft diskutiert, ebenso Tumorentitäten, insbesondere Darmkrebs, Lungenerkrankungen (obstruktive Schlafapnoe), endokrine Erkrankungen (Hypothyreose) und systemische mit NALFD assoziierte Phänomene (z. B. Eisenüberladung und Thromboseneigung). Neben der Fokussierung auf die Pathogenese dieser extrahepatischen Manifestationen werden klinische Implikationen hervorgehoben. Bislang gibt es in Deutschland keine für die Indikation NAFLD zugelassenen Medikamente. Die neue NAFLD-Leitlinie bietet einen Ausweg aus diesem „therapeutischen Nihilismus“. Diagnostische und therapeutische Algorithmen, basierend auf metabolischen Komorbiditäten und dem Fibrosestadium, sind praxisrelevant gestaltet und im ärztlichen Alltag anwendbar. Daher können klare Basismaßnahmen sowie medikamentöse Empfehlungen bei NAFLD in Abhängigkeit von Komorbiditäten und Fibrosestadien gegeben werden.

Abstract

Nonalcoholic fatty liver disease (NAFLD) is nowadays the leading cause of chronic liver disease worldwide and shows a strong association with the metabolic syndrome. The NAFLD is a systemic disease associated with a plethora of extrahepatic manifestations and comorbidities, such as type 2 diabetes, obesity and dyslipidemia. These extrahepatic disorders are related either to secondary effects of the associated obesity or to pathophysiological effects of insulin resistance in NAFLD. The three most common causes of the observed increased morbidity and mortality associated with NAFLD are cardiovascular diseases, liver diseases, such as cirrhosis, and cancer. In this overview, cardiovascular diseases, type 2 diabetes mellitus and chronic kidney diseases in connection with NAFLD are discussed as examples, as well as tumor entities, in particular colon cancer, lung diseases (obstructive sleep apnea), endocrine diseases (hypothyroidism) and systemic phenomena associated with NAFLD (e.g. iron overload and thrombophilia). In addition to focusing on the pathogenesis of these extrahepatic manifestations, the clinical implications are highlighted. So far there are no drugs approved for the indication NAFLD in Germany. The new NAFLD S2k guidelines offer a way out of the current “therapeutic nihilism”. Diagnostic and therapeutic algorithms based on the metabolic comorbidities and the stage of fibrosis are designed with practical relevance and can be used in everyday medical practice. Therefore, clear basic measures and drug recommendations can be given for NAFLD depending on the comorbidities and stage of fibrosis.

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  1. Schwerpunkt Gastroenterologie, Zentrum für Innere Medizin, Justus-Liebig-Universität & Universitätsklinikum Gießen, Klinikstr. 33, 35392, Gießen, Deutschland

    Elke Roeb MHAC

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E. Roeb hat in den letzten 3 Jahren Honorare für Vorträge, Artikel und Beratung von folgenden Firmen erhalten: Abbvie, BMS (Bristol-Myers Squibb), Falk Foundation, Gilead, Intercept, Medac, Merz Pharma, Norgine, Pfizer, Repha, Takeda. In Bezug auf den Inhalt des Artikels gibt es keine Interessenskonflikte.

Für diesen Beitrag wurden von der Autorin keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Roeb, E. Nichtalkoholische Fettlebererkrankung. Innere Medizin 64, 323–328 (2023). https://doi.org/10.1007/s00108-022-01448-z

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