Role of insulin resistance and extra hepatic signalling in fatty liver disease

摘要

Non-alcoholic fatty liver disease (NAFLD) is a spectrum of liver pathology that ranges from non-alcoholic fatty liver (NAFL, simple steatosis), on the most clinically benign end of the spectrum, to cirrhosis on the opposite extreme where most liver-related morbidity and mortality occurs. Non-alcoholic steatohepatitis (NASH) is an intermediate stage of liver damage that is characterized by overtly increased liver cell death in fatty livers. This sometimes triggers hepatic infiltration with inflammatory cells and accumulation of fibrous tissue. Thus it is not surprising that the risk of progressing to cirrhosis is greater in individuals with NASH than in those with NAFL. Over the past decade considerable progress has been made in delineating the mechanisms that cause NAFL and NASH It remains less evident why only a minority of individuals with these 'early' stages of NAFLD progress to cirrhosis or develop liver cancer. The purpose of this chapter is to summarize current understanding of the role of insulin resistance and extrahepatic signalling in the pathogenesis of fatty liver disease.