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Title 9. 各論 : 非アルコール性脂肪性肝疾患の診断と治療
Subtitle 特集 肝障害の相談を受けたとき - 最近よくみる症例の特徴 -
Authors 角田圭雄*1, 石破博*2, 藤井英樹*3, 小野正文*4, 鎌田佳宏*5, 高橋宏和*6, 川口巧*7, 中島淳*8, 伊藤義人*9, 岡上武*10
Authors (kana)
Organization *1愛知医科大学肝胆膵内科, *2JR大阪鉄道病院消化器内科, *3大阪市立大学肝胆膵内科, *4香川大学肝・胆・膵内科学先端医療学講座, *5佐賀大学医学部附属病院肝疾患センター, *6大阪大学大学院医学系研究科生体物理工学講座, *7久留米大学消化器内科, *8横浜市立大学肝胆膵消化器病学, *9京都府立医科大学消化器内科, *10大阪府済生会吹田病院
Journal 肝臓クリニカルアップデート
Volume 7
Number 2
Page 171-178
Year/Month 2022 / 4
Article 報告
Publisher 医学図書出版
Abstract 「要旨」 脂肪肝を診た際には内分泌疾患や薬物投与の有無を評価する. 飲酒歴や他の慢性肝疾患がなければNAFLDと診断できる. 高度線維化例を除外するにはFIB-4 indexを1st stepと活用し, 2nd stepとして4型コラーゲン7Sを測定し, 肝臓専門医への紹介を検討する. 肝臓専門医はエラストグラフィや肝生検の施行を考慮する. 治療としてはライフスタイルの改善が第一であるが, 非糖尿病NAFLD患者ではビタミンEの投与を勧める. 糖尿病合併例ではSGLT2阻害薬やGLP-1受容体作動薬が期待できる. 脂質異常症合併例ではペマフィブラートが有効である. 現在NASHに対する開発治験が進行しており, 新規薬剤の登場を期待したい.
Practice 臨床医学：内科系
Keywords FIB-4 index, 4型コラーゲン7S, エラストグラフィ, tipe IV collagen 7S, elastography
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