NASH (nicht alkoholische Steatohepatitis): Fettleber oder fatale Lebererkrankung?

Zusammenfassung

Einleitung: Die nicht alkoholische Steatohepatitis (NASH) hat sich von einer anekdotischen Erkrankung, die erstmals 1980 beschrieben wurde, zu einer der am häufigsten diagnostizierten Lebererkrankungen der aktuellen Dekade entwickelt.

Methode: In der folgenden Übersichtsarbeit werden auf dem Boden einer selektiven Literaturrecherche der Datenbank PubMed sowie eigener Erfahrungen grundlegende Aspekte der Pathophysiologie, Diagnostik und Therapie sowie das aktuelle Management der Erkrankung beleuchtet.

Ergebnisse: In den Anfängen der Erforschung der nicht alkoholischen Steatohepatitis wurden bereits das Potenzial zur schwerwiegenden Leberzerstörung und die Erhöhung der leberassoziierten Mortalität gesehen. Mit Kenntnis der Insulinresistenz als präkonditionierende Eigenschaft der NASH-Patienten wurde ein wichtiger Meilenstein in der Diagnostik und auch im therapeutischen Ansatz erreicht. Daraufhin wurden Patienten mit metabolischem Syndrom verstärkt auf eine NASH-Erkrankung hin untersucht. Natürlich tritt die NASH auch parallel zu anderen Lebererkrankungen auf und kann deren Verlauf verstärken. NASH sollte in der modernen Medizin keine Ausschlussdiagnose sein, sondern als eigenständige Lebererkrankung diagnostiziert werden. Darüber hinaus hat die Steatohepatitis auch Konsequenzen für den systemischen Kreislauf. NASH verschlechtert eine Insulinresistenz, aggraviert metabolische Komplikationen und erhöht das Risiko für kardiovaskuläre Erkrankungen.

Ausblick: Die Prioritäten zukünftiger Forschung sind die Optimierung nicht invasiver Screeningstrategien, die Identifizierung von Risikofaktoren, die Evaluation der hepatozellulären Karzinogenese auf dem Boden einer NASH sowie die Evaluation innovativer therapeutischer Zielstrukturen.

Abstract

Introduction: Non-alcoholic steatohepatitis (NASH) was first described in 1980 and has emerged from an anecdotal disease to a widely distributed liver disease in the current decade.

Methods: This review is based on publications in PubMed and our own experiences and deals with basic pathophysiological aspects, diagnostic, and therapeutic tools as well as with the modern management of this serious liver disease.

Results: For a long time the potenial for serious liver destruction and enhanced liver mortality by NASH has been observed. The recognition of the metabolic origin of NASH has contributed to diagnostic as well as therapeutic approaches. Since then patients with metabolic syndrome are often screened for liver disease. NASH might worsen other chronic liver diseases but should be judged as an independent illness rather than the exclusion of other potential liver diseases. Furthermore, non-alcoholic steatohepatitis has systemic consequences concerning insulin resistance, metabolic complications and cardiovascular diseases.

Perspectives: Future research should concentrate on non-invasive screening strategies, identification of risk factors, evaluation of hepatocellular carcinogenesis and new therapeutic targets.

Schlüsselwörter

Steatohepatitis - NASH - Leberfibrose - Therapie

Key words

steatohepatitis - NASH - liver fibrosis - therapy

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