非酒精性脂肪性肝病与慢性肾病关系的研究进展

杨梦茹; 韩睿

doi:10.3969/j.issn.1001-5256.2022.11.030

非酒精性脂肪性肝病与慢性肾病关系的研究进展

DOI: 10.3969/j.issn.1001-5256.2022.11.030

杨梦茹,
韩睿^, ,

昆明医科大学第一附属医院内分泌二科，昆明 650032

基金项目:

国家自然科学基金 (81960157);

云南省自然科学基金 (2019FE001[-006]);

云南省卫生健康委员会医学领军人才基金 (L-2019015);

昆明医科大学2型糖尿病微血管病变诊疗科技创新团队基金 (CXTD2020xx)

利益冲突声明：所有作者均声明不存在利益冲突。

作者贡献声明：杨梦茹负责课题设计，查阅文献，撰写论文；韩睿指导文章撰写及修改、校阅论文。

详细信息

通信作者:
韩睿，tnb5324888@yeah.net

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出版历程
- 收稿日期: 2022-04-17
- 录用日期: 2022-05-30
- 出版日期: 2022-11-20

Research advances in the relationship between nonalcoholic fatty liver disease and chronic kidney disease

Mengru YANG,
Rui HAN^{,
,}

Second Department of Endocrinology, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China

Research funding:

National Natural Science Foundation of China (81960157);

Natural Science Foundation of Yunnan Province (2019FE001[-006]);

Medical Leading Talent Fund of Yunnan Provincial Health Commission (L-2019015);

Scientific and Technological Innovation Team Fund of Kunming Medical University for the Diagnosis and Treatment of Type 2 Diabetes Microangiopathopathy (CXTD2020xx)

More Information

Corresponding author: HAN Rui, tnb5324888@yeah.net(ORCID: 0000-0002-4409-8797)

摘要

摘要: 越来越多的研究表明非酒精性脂肪性肝病(NAFLD)与慢性肾病(CKD)紧密相关。虽然其中的因果关联还未能阐明，但代谢失调、饮食-肠道菌群轴失调、氧化应激、血小板激活、遗传学与表观遗传学调控等机制在疾病交互网络中起到了重要作用。本文在综述NAFLD与CKD之间关联证据、NAFLD以及与NAFLD密切相关的因素可能增加CKD发生风险的潜在机制基础上，一并提出了患者管理建议及治疗策略。
- 非酒精性脂肪性肝病 /
- 肾病 /
- 病理过程
Abstract: More and more studies have shown that nonalcoholic fatty liver disease (NAFLD) is closely associated with chronic kidney disease (CKD). Although the causal relationship has not been clarified, the mechanisms, such as metabolic disorders, diet-intestinal microbiota axis disorders, oxidative stress, platelet activation, and genetic and epigenetic regulation, play an important role in the disease interaction network. This article reviews the evidence for the association between NAFLD and CKD and the potential mechanisms under which NAFLD and its related factors may increase the risk of CKD, and moreover, it proposes related patient management recommendations and treatment strategies.
- Non-alcoholic Fatty Liver Disease /
- Nephrosis /
- Pathologic Processes

HTML全文

表 1 建议用于NAFLD患者肾功能评估的监测指标及优缺点

Table 1. Recommended monitoring indicators and their advantages or disadvantages for renal function evaluation in NAFLD patients

监测指标	优点	缺点
血清肌酐	经济便捷	受年龄、性别、肌肉含量、饮食、运动、种族、溶血等因素影响
尿素氮	经济便捷	受出血、肝功能、营养水平影响
尿蛋白	经济	24 h尿标本收集不便，受年龄、性别、运动、肌肉含量、妊娠等因素影响
随机尿白蛋白/肌酐比值	经济便捷	受感染、发热、显著高血糖、未控制的高血压、运动、心力衰竭、月经等因素影响
GFR	金标准	复杂、昂贵、侵入性检查
基于血清肌酐的eGFR计算公式
Cockcroft-Gault公式	经济便捷	受年龄、性别、肌肉含量、饮食、运动、种族、溶血等因素影响，且极端体质量人群中不准确
肾脏病饮食改良公式	经济便捷，不受体质量影响	受年龄、性别、肌肉含量、饮食、运动、种族、溶血等因素影响
CKD-EPI公式	经济便捷	受年龄、性别、肌肉含量、饮食、运动、种族、溶血等因素影响
基于血清肌酐与胱抑素C的eGFR计算公式
CKD-EPI胱抑素C公式	经济便捷，较单独基于血清肌酐的公式计算eGFR更加精准	基于中国人的胱抑素C公式有待开发
CKD-EPI肌酐-胱抑素C公式	经济便捷，诊断精确性较此前临床常用的传统公式高	肝硬化与非肝硬化患者相比，对前者肾功能的评估准确性稍差
注：CKD-EPI，CKD流行病学合作研究。

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