脂肪肝篩檢與監控之原則：流

程示意圖
張明鈴
林口長庚醫院 肝膽胃腸科 肝病研究中心 0416
10
腹部超音波診斷為脂肪肝之病人

(A)致病原因評估
(B)肝臟發炎及纖維化評估
(C)肝臟疾病評估
(D)心血管疾病評估
(E) 家族史

(A) 致病原因和 (D) 心血管疾病應同時評估

 (A) 致病原因評估
1. 營養狀態
a. (Sex, age, menopause age, body weight, heigh
t, BMI, waist circumference, history of parenter
al nutrition in 1 week)
b. History of parenteral nutrition in 1 week
2. 新陳代謝症候群與疾病
3. 藥物史
4. 手術史
5. 環境中有害物暴露
 (B) 肝臟發炎及纖維化評估

1. 肝臟發炎
2. 肝臟纖維化
 (C) 肝臟疾病之評估

1. HBV
2. HCV
3. PBC
4. autoimmune hepatitis
5. Wilson’s disease
 (D) 心血管疾病評估

1. Risk assessment
2. Examinations
 (E) 家族史

• DM, H/T, CVD, CVA, dislipidemia, hyperuri

cemia, fatty liver, overweight or obesity,
malignancy, thyroid dysfucntion or any oth
er disease related to metabolic dysfucntion
or liver disease
(A) 致病原因評估
 1-b. History of parenteral nutrition in 1 week
1-b. History of parenteral nutrition in 1 week

Yes No

Cause survey

Rapid body weight loss(1 months:3%, 3 months:5%; 6 months:10%)

No
Yes

Causes survey
(malignancy, metabolic
dysfunction….)
22

Treat disease
 5. 環境中有害物暴露 (exposure history in 6 months): Hydrocarbons; industrial solvents
5. 環境中有害物暴露 (exposure history in 6 months): Hydrocarbons; industrial solvents
Exposure history
Exposure history

Positive Negative

Discontinue exposure, liver functi

on f/u for 3~6 months, ECHO f/u f
or 6~12 months

BB

BB
(B) 肝臟發炎及纖維化評估
(C) 肝臟疾病之評估
(D) 心血管疾病評估
(E) 家族史
 Postmenopausal syndrome
• Menopause: is the permanent cessation of ovari
an function occurring some time before the end
of the natural lifespan.
• postmenopause :applied to women who still hav
e a uterus, and are not pregnant or lactating, an
d have not experienced a menstrual bleed for at
least 12 months. In women without a uterus, me
nopause or postmenopause is identified by a ver
y high FSH level
• Postmenopausal syndrome:hot flashes, irritability
, mood swings, insomnia, dry vagina
Polycystic ovarian disease (PCOD)
• one of the most common female endocrine disorders aff
ecting approximately 5%-10% of women of reproductive
age (12-45 years old) and was once thought erroneously
to be one of the leading causes of infertility.
• principal features :obesity, anovulation (resulting in irreg
ular menstruation), acne, and excessive amounts or effe
cts of androgenic (masculinizing) hormones.
• insulin resistance, diabetes, and obesity are all strongly c
orrelated with PCOD.
• Diagnosis: Gynecologic ultrasonography , serum androge
n
 Physical therapy

• Physical activities benefits NAFLD beyond

encouraging weight reduction
• 1% weight reduction=> 8% ALT
improvement