Die nichtalkoholische Steatohepatitis (NASH) als Ursache erhöhter Leberwerte

Die nichtalkoholische Steatohepatitis (NASH) ist die progrediente Verlaufsform der nichtalkoholischen Fettlebererkrankung (NAFLD) und durch eine erhöhte entzündliche Aktivität gekennzeichnet, die in einer Leberfibrose bzw. Leberzirrhose resultieren kann. NASH-Aktivität und Leberfibrose sind die prognoserelevanten Risikofaktoren, sodass eine rationale Stufendiagnostik, Identifikation von Risikopersonen und ein zielgerichteter Einsatz der therapeutischen Möglichkeiten entscheidend ist.

Abstract

Non-alcoholic steatohepatitis (NASH) is the progressive entity of non-alcoholic fatty liver disease (NAFLD) and characterised by increased inflammatory activity, potentially resulting in liver fibrosis and ultimately cirrhosis. NASH activity and hepatic fibrosis are the prognosis determinating risk factors – rational stepwise diagnostic approaches are urgently needed as therapeutic options beyond lifestyle modifications are limited.

Kernaussagen

• Die nichtalkoholische Fettlebererkrankung (NAFLD) ist die häufigste chronische Lebererkrankung und damit eine führende Ursache erhöhter Leberwerte.

• Ein Screening der Allgemeinbevölkerung auf eine NAFLD ist trotz der hohen Prävalenz nicht praktikabel und sollte daher mithilfe einfacher, nicht invasiver diagnostischer Verfahren auf Risikopopulationen (z.B. Adipositas, Typ-2-Diabetes) fokussiert werden.

• In der nicht zirrhotischen NAFLD sind insbesondere kardiovaskuläre Erkrankungen, metabolische Risikofaktoren und extrahepatische Tumorerkrankungen prognoserelevant.

• Leberfibrose (≥F3) und Leberzirrhose bestimmen die Prognose und sind die wichtigsten Risikofaktoren für hepatische Komplikationen, Morbidität und Mortalität.

• Es gibt keine spezifisch zugelassene, medikamentöse Therapie der NAFLD; Behandlungsstrategien beinhalten eine Lebensstilmodifikation, die Behandlung von Komorbiditäten und Komplikationen sowie ein regelmäßiges und interdisziplinäres Monitoring.

Schlüsselwörter

nichtalkoholische Fettlebererkrankung (NAFLD) - nichtalkoholische Steatohepatitis (NASH) - Leberfibrose - Risikostratifikation - nicht invasive Diagnostik

Keywords

Non-alcoholic fatty liver disease (NAFLD) - non-alcoholic steatohepatitis (NASH) - liver fibrosis - risk stratification - non-invasive diagnostics

Publication History

Article published online:
26 June 2023

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