{"id":15216,"date":"2017-01-26T10:15:09","date_gmt":"2017-01-26T09:15:09","guid":{"rendered":"https:\/\/dev.93-93-113-41.plesk.page\/ca\/?p=15216"},"modified":"2024-04-02T09:02:24","modified_gmt":"2024-04-02T07:02:24","slug":"esteatosi-hepatica","status":"publish","type":"post","link":"https:\/\/dev.93-93-113-41.plesk.page\/ca\/esteatosi-hepatica\/","title":{"rendered":"Esteatosi Hep\u00e0tica no Alcoh\u00f2lica i Diabetis tipus 2"},"content":{"rendered":"

La Esteatosi Hep\u00e0tica (col\u00b7loquialment fetge gras) consisteix en el dip\u00f2sit de greix a nivell del fetge, que es pot acompanyar o no d’inflamaci\u00f3 i \/ o fibrosi. Es subdivideix en funci\u00f3 de si es deu a un consum excessiu d’alcohol o no.<\/p>\n

En l’actualitat, l’esteatosi hep\u00e0tica no alcoh\u00f2lica s’ha convertit en la causa m\u00e9s comuna de malaltia hep\u00e0tica cr\u00f2nica als pa\u00efsos d’occident. Segons els \u00faltims estudis podria afectar fins a un 40-50% de la poblaci\u00f3, sent molt m\u00e9s freq\u00fcent en persones amb Diabetis Mellitus tipus 2<\/a>. En concret, s’ha objectivat que la majoria dels aquests pacients tenen fetge gras, i que fins a la meitat d’ells, el dip\u00f2sit de greix pot donar lloc a inflamaci\u00f3 hep\u00e0tica (en termes m\u00e8dics esteatohepatitis). A m\u00e9s, la pres\u00e8ncia d’esteatosi hep\u00e0tica dificulta el control de la diabetis i, en aquells pacients tractats amb insulina, necessitat de majors dosis d’aquesta.<\/p>\n

La pres\u00e8ncia de greix a nivell hep\u00e0tic, a m\u00e9s de donar lloc a augment de citoquines (unes subst\u00e0ncies inflamat\u00f2ries), origina elevaci\u00f3 dels \u00e0cids grassos lliures, el que es tradueix en una dislip\u00e8mia mixta, t\u00edpicament caracteritzada per augment de triglic\u00e8rids i LDL (el que coneixem com a “colesterol dolent”) i descens del HDL (o “colesterol bo”). La inflamaci\u00f3 subcl\u00ednica, juntament amb la dislip\u00e8mia i la diabetis, promouen l’aparici\u00f3 prematura de malaltia cardiovascular, motiu pel qual \u00e9s important diagnosticar de forma preco\u00e7 i tractar l’esteatosi hep\u00e0tica.<\/p>\n

At\u00e8s que aquesta malaltia no sol ocasionar s\u00edmptomes ni signes, \u00e9s el metge qui ha de sospitar i, segons el risc del pacient, sol\u00b7licitar les exploracions complement\u00e0ries necess\u00e0ries per al seu diagn\u00f2stic. En una anal\u00edtica rutin\u00e0ria, s’acostuma a objectivar elevaci\u00f3 dels enzims hep\u00e0tics (ALT i AST), per\u00f2 la seva normalitat no exclou el diagn\u00f2stic. Actualment, la prova m\u00e9s utilitzada, per la seva disponibilitat i senzillesa de realitzaci\u00f3, \u00e9s la Ecografia hep\u00e0tica. A m\u00e9s, en aquells pacients amb esteatosi moderada o greu es recomana la realitzaci\u00f3 d’un FibroScan <\/a>per avaluar la pres\u00e8ncia i el grau de fibrosi o cirrosi associada a aquesta.<\/p>\n

El tractament de l’esteatosi hep\u00e0tica en diab\u00e8tics inclou tant canvis en l’estil de vida, com f\u00e0rmacs per a la Diabetis i la Dislip\u00e8mia<\/a>. Es recomana perdre pes, mitjan\u00e7ant una dieta baixa en sucres simples i en greixos saturats. Amb nom\u00e9s disminuir un 7-10% el pes, ja s’observa millora en el dip\u00f2sit de greix hep\u00e0tic. Pel que fa al tractament de la diabetis, el f\u00e0rmac que ha demostrat ser m\u00e9s efica\u00e7 en la millora de l’esteatosi \u00e9s la Pioglitazona, tot i que les seves indicacions s\u00f3n restringides a causa dels efectes secundaris que origina. El Liraglutide, que s’usa tant per a la diabetis com per perdre pes, ha mostrat tamb\u00e9 resultats favorables. Per al tractament de la dislip\u00e8mia es recomanen en primer lloc les Estatines, i en segon els Fibrats.<\/p>\n

A Cl\u00ednica ServiDigest els Departaments de Digestiu, Endocrinologia i Nutrici\u00f3, actuen de forma conjunta i coordinada per al diagn\u00f2stic i abordatge tant de la Diabetis com de la Esteatosi hep\u00e0tica, amb l’objectiu de detectar ambdues de forma preco\u00e7 i proporcionar-li el tractament m\u00e9s adequat i adaptat a la seva situaci\u00f3 cl\u00ednica.<\/p>\n

Dra. Gemma Cuixart Carruesco
\nEspecialista en Endocrinologia i Nutrici\u00f3
\nCol\u00b7legiada n\u00fam 48408 del Col.legi Oficial de Metges de Barcelona
\nServei d\u2019Endocrinologia i Nutrici\u00f3 de Cl\u00ednica ServiDigest<\/p>\n","protected":false},"excerpt":{"rendered":"

En l’actualitat, l’esteatosi hep\u00e0tica no alcoh\u00f2lica s’ha convertit en la causa m\u00e9s comuna de malaltia hep\u00e0tica cr\u00f2nica als pa\u00efsos d’occident. […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":15210,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[828],"tags":[105,94,178,764],"class_list":{"0":"post-15216","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-articles-medics","8":"tag-diabetis","9":"tag-endocrinologia-ca","10":"tag-esteatosi-hepatica","11":"tag-prevencio-2"},"yoast_head":"\nEsteatosi Hep\u00e0tica no Alcoh\u00f2lica i Diabetis tipus 2 - Servidigest<\/title>\n<meta name=\"description\" content=\"La Esteatosi Hep\u00e0tica consisteix en el dip\u00f2sit de greix a nivell del fetge, que es pot acompanyar o no d'inflamaci\u00f3 i \/ o fibrosi.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/dev.93-93-113-41.plesk.page\/ca\/esteatosi-hepatica\/\" \/>\n<meta property=\"og:locale\" content=\"ca_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Esteatosi Hep\u00e0tica no Alcoh\u00f2lica i Diabetis tipus 2 - 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