1. Health promotion and education, lifestyle change
Through health education, unhealthy lifestyles and behaviors can be corrected, and it is suggested that calorie intake should be moderately restricted, and the daily calorie intake of obese adults should be reduced by 2092? 4 184kJ(500？ l 000 kcal)； Change the dietary composition, suggest a balanced diet with low sugar and low fat, reduce the intake of sucrose-containing drinks, saturated fat and trans fat, and increase the dietary fiber content; Moderate aerobic exercise, more than 4 times a week, and the cumulative exercise time is at least 150 minutes.
2. Control your weight and reduce your waistline
If obese NAFLD patients change their lifestyle 6? /kloc-weight loss failed to exceed 5% in 0/2 months, so it is suggested that metformin, sibutramine and orlistat should be carefully selected for secondary intervention. Unless there is liver failure and moderate to severe esophageal and gastric varices, patients with severe obesity can consider upper digestive tract bariatric surgery if drug bariatric treatment fails.
3. Improve insulin resistance and correct metabolic disorder.
According to clinical needs, related drugs can be used to treat metabolic risk factors and their complications. Unless there is obvious liver injury (such as serum transaminase exceeding 3 times the upper limit of normal value), abnormal liver function or decompensated cirrhosis, patients with NAFLD can safely use angiotensin receptor blockers, insulin sensitizers (metformin, pioglitazone, rosiglitazone) and statins to lower blood pressure and prevent glucose and lipid metabolism disorder and arteriosclerosis.
4. Reduce additional blows and avoid aggravating liver damage.
Patients with NAFLD, especially NASH, should avoid sharp weight loss, prohibit extremely low-calorie diet and air ileum short-circuit surgery to lose weight, avoid excessive growth of small intestinal bacteria, avoid contact with hepatotoxic substances, use Chinese and western medicines and health products that may be hepatotoxic with caution, and prohibit excessive drinking.
5. Liver-protecting and anti-inflammatory drugs for preventing and treating hepatitis and fibrosis
On the premise of basic treatment, liver-protecting and anti-inflammatory drugs are mainly used for adjuvant treatment in the following situations: ① NASH patients diagnosed by liver histology; ② Clinical manifestations, laboratory changes and imaging examination suggest that there may be obvious liver injury and/or progressive liver fibrosis, such as elevated serum transaminase, metabolic syndrome and NAFLD patients with type 2 diabetes; ③ The drug to be used may cause liver injury, affect the implementer of basic treatment scheme, or increase serum transaminase during basic treatment; ④ Patients with hepatotropic virus infection or other liver diseases.
It is suggested that polyene phosphatidylcholine, silymarin, glycyrrhizic acid preparation, ursodeoxycholic acid, S- adenosylmethionine and reduced glutathione should be selected reasonably according to disease activity, disease stage, drug efficacy and price. There are two kinds of Chinese and western medicine, and the course of treatment generally takes 6? Over 12 months.
6. Actively deal with the complications of liver cirrhosis.
According to clinical needs, corresponding measures should be taken to prevent and treat portal hypertension and complications of liver failure in liver cirrhosis. Patients with NASH complicated with liver failure, decompensated cirrhosis and NAFLD complicated with hepatocellular carcinoma can consider liver transplantation.