200182001 2001;9(6):3252003 2003;11(2):71200252005622006 2006;14(3):161

NAFLDALDNAFLDALD

III-1II-2II-3III

FLDIR// FLD

FLDAGA,2002 1 2 1 2 (insulin resistance.IR) /

ALDNAFLD ALD NAFLD 15 65 85 54330Mallory 16 3 7 76 96 53/ 63 38 /

Fong 2000; Sugimotom 2003

ASHNASH ASH NASH 29%71% 23%78% 88% 23%ALT/AST>1

Falck-yeter 2001Sugimotom 2003

FLD:AASLD(2003)

/ 50-70% 20-30% NASH/2-5%

NAFLD 1567

(NASH) NASH

123413

131413ALT4

NASHNASH-F04G03S04FGS

NASH123413NASH

NASHNASHCCNASHNASHCCNASH10 HCCCCHCC

NASH>45IITGALTAST >ALT>110%/wilson

BMI BMI(Kg/m2)

2h),HbA1CBMI/FFATCHDL-C,LDL-C,TGCRPGSH,GSH/GSSH,GST,SOD,S-NOMDA,LPOAGAALT,AST,GGT,ALP,PT,5-LDH

NAFLD/

6FRAMESmenu/

/kg/d500-1000(1=418KJ)4007700g15%-20%

H2O+CO250-70%70-80%203573000/305d/wHR170-30044.5

NAFLD

IDF)200536TC6.46mmol/LLDL-C4.16mmol/LHDL-C0.90mmol/LTG 2.26mmol/L II-2)LDL-CHDL-CII-2TGII-1

IDF)20055%0.45kgBMI30BMI272 >102cm>85cm TG >1.69mmol/l HDL-C6.1mmol/lIDF)2005IDF)2005IDF)2005

NAFLDSabuncu T,et al. Rom J Gastroenterology 2003;12:189

131210.2%8.4%IR47%40%AST41%39%ALT59%58%GGT27%25%B118ALP9%14%

NASH10NASH466Harrison SA,et al. Aliment Pharmacol Ther 2004;20:623

PBMI43.439.8.007HbA1c7.145.95.021ALT9354.009AST7948.00863

6100.450.9kg/1.2 kg/0.5 kg/0.45 kg/1.5kg/5 kg/

185B 60 12532 :84Med J Qilu 2000;15(4)(II-1)

(II-1)

E II-3) NASH11E4001200IU/4-10

Lavine JE.J Pediatr 2000136:734-8

PBMI kg/m(2)32.8 +/- 3.832.5 +/- 4.4 >0.05ALT IU/L 175 +/- 10640 +/- 26

II-3):TNF20NASH6-121,600 mg/dII-3) :ATII7NASH50mg/d)48II-2/II-3III)

(ALD)

540g/d20g/d2>80g/dASTALTGGTPTMCV4AST/ALT>2BCT

12351245125

g=ml%0.8

ALTASTALTASTGGTTBilGGTAST/ALT-A1TBil2

ALD70809090ALD803051118237>40g >5ALD4.341.21AF0.94ASH1.51,AC0.683613AF>20g/d8.2 40g/d13.156.8 >80160g/d8AF5101035ASH820ACAF1.53.2

ALD030 60-100% 20-30% ASH10% / Day,2003

ALDFibrotest2MAApoA1 GGT7FTFTALTFTATLaineHA

Child-Turcotte-Pugh(CTP):C>10MELD640903MaddreyDF)DF 4.6PTsTBilmg/dlDF >323

2-43-650%11-13

(Acamprosate)(I)12g333mgII-1)

ASTALTAST175h ALT4710hAST87h36ASHGGT710ALD2845CDT1523

(I)ALD586.75.4h 0.95h 2.34h

Shpilenya LS, et al.Alcohol Clin Exp Res 2002;26:340

I)4146ALDMetaALD 2005;10:5

Stewart SF,Day CP. J Hepatol 2003;38:S2-13

III-1II-1InfliximabII-2II-2

Stewart SF,Day CP. J Hepatol 2003;38:S2-13

II-1S-II-1II-1---

AGA Technical Review on NAFLD. Gastroenterology 2002;123:170.

MetaVitE3UNOSMELD[0.957loge(creatinine,mg/dl)+0.378loge(bilirubin,mg/dl)+1.12loge(INR)+0.643,rounded,multipliedby10]MELD640Child-Turcotte-PughCTP7MELD12MELD Infliximab:TNF alpha RCTMetaRCT;--RCTMeta