近來腹部超音波檢查非常普遍,健康檢查也大都包括此項。許多人於檢查後被告知有脂肪肝,然而什麼是脂肪肝?要不要緊?什麼原因造成的?會不會轉變為肝硬化及肝癌?
一般俗語稱脂肪肝為「肝包油」,其實這是錯誤的說法。這些「油」並非包在肝臟表面,而是肝細胞(構成肝臟最主要的細胞)裡面充滿著脂肪泡粒,使得肝細胞變大,整個肝臟也變得腫脹。因為脂肪的堆積增加,於是肝臟的外觀由原來的深棕色(豬肝色)變為黃色,就是「粉肝」的顏色。
肝臟的諸多功能之一就是代謝脂肪。食物中的脂肪被消化為脂肪酸而進入肝臟代謝,成為膽固醇及三酸甘油脂(或稱中性脂肪)後運出肝臟外面。若這個過程出了問題,即會造成三酸甘油脂積在肝細胞內形成脂肪泡粒,於是乎脂肪肝就形成了。
脂肪肝可分為「大泡性脂肪肝」與「小泡性脂肪肝」兩類。大泡性脂肪肝的肝細胞被少數一、二個大脂肪泡佔據,於是細胞核被擠到一邊。小泡性則是肝細胞內充滿許多小小的脂肪泡,但是細胞核仍維持在中間。大泡性脂肪肝一般與病毒性肝炎無關,較常見的原因是酗酒,高脂血症(尤其三酸甘油脂升高),糖尿病或肥胖症。小泡性脂肪肝的成因包括懷孕末期急性脂肪肝,服用大量四環黴素,或小兒的雷氏症候群。酗酒引起的脂肪肝會合併有酒精性肝炎,長久的發炎也會導致肝硬化甚至肝癌。至於肥胖、糖尿病、高脂血症引起的脂肪肝一般認為不會進展到肝硬化,因此不會直接危及生命,但是近來的一些醫學報告指出這些原因的脂肪肝也有可能造成一種稱之為“脂肪性肝炎”,這種肝炎也有可能發展成肝硬化。這個新理論仍待進一步證實。由我們的臨床經驗觀察,即使真的如此,其可能性也是很低很低的。
大泡性脂肪肝通常沒有自覺症狀,只有在嚴重的脂肪肝造成肝臟明顯腫大時方可能會有右上腹膨脹感。但是如果是酗酒引起的脂肪肝就可能伴有酒精性肝炎,出現肝炎的症狀,如噁心、厭食、倦怠甚至黃疸。小泡性脂肪肝則較嚴重多了,通常併有急性肝衰竭的症狀,死亡率高。有這種急症就必須住院治療。
診斷脂肪肝最簡便的方法就是超音波檢查,而且準確率高達97%。抽血檢查GOT、GPT一般是正常或稍高(100單位以下),若是太高,則需考慮是否合併其他原因(如病毒性肝炎)或是脂肪性肝炎。
一般常見的大泡性脂肪肝的原因(酗酒、肥胖、高脂血症、糖尿病)大都與現代的生活形態有關,可說是營養過剩的文明病。事實上這些脂肪肝並沒有特殊藥物可治療,治療的方法還是要依靠去除原因,例如確實戒酒、減肥、少吃油膩食物、控制血脂肪、控制糖尿病等等,並多運動,只要持之以恆,脂肪肝自然會消失。affair dating sites
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