非酒精性脂肪肝病 (NAFLD) 已成为肝病的主要原因，影响着全球 30% 的人口。 NAFLD 在肥胖个体和 2 型糖尿病 (T2DM) 患者中的患病率特别高。 NAFLD 的范围从简单的肝脏脂肪沉积到坏死性炎症和纤维化（非酒精性脂肪性肝炎 (NASH)）、NASH 肝硬化和/或肝细胞癌。胰岛素抵抗在 NAFLD 发病机制中起着关键作用，此外还有脂肪细胞失调、线粒体功能障碍、遗传因素和肠道微生物群的变化。由于胰岛素抵抗也是 T2DM 的主要诱发因素，因此使用抗糖尿病药物来治疗 NAFLD 似乎是合理的。在这篇综述中，我们提供了一些最广泛使用的抗糖尿病药物的 NAFLD 相关作用机制，即二甲双胍、吡格列酮、钠-葡萄糖转运蛋白 2 抑制剂 (SGLT2i)、胰高血糖素样肽 1 受体类似物 (GLP1 RA) 和二肽基肽酶 4 抑制剂 (DPP4i)，并提供有关其在患有以下疾病的患者中使用的可用数据NAFLD，伴或不伴 T2DM。二甲双胍和 DPP4i 都显示出相当矛盾的结果，而吡格列酮似乎对 NASH 患者有益，因此是唯一被所有主要肝脏协会批准用于治疗伴有显着肝纤维化的 NASH 的药物。另一方面，SGLT2i 和 GLP1 RA 似乎对 NAFLD 患者有益，显示出显着的结果，其中 SGLT2i 在迄今为止唯一的头对头研究中被证明更有效。 在 NAFLD 合并糖尿病患者中，吡格列酮、GLP1 RA 和 SGLT2i 似乎是合理的治疗选择。在将这些药物推荐给非糖尿病患者之前，需要进行更大规模的研究。© 2023。作者。

Non-alcoholic fatty liver disease (NAFLD) has become a leading cause of liver disease, affecting 30% of the global population. NAFLD prevalence is particularly high in obese individuals and patients with type 2 diabetes mellitus (T2DM). NAFLD ranges from simple fat deposition in the liver to necroinflammation and fibrosis (non-alcoholic steatohepatitis (NASH)), NASH-cirrhosis, and/or hepatocellular carcinoma. Insulin resistance plays a key role in NAFLD pathogenesis, alongside dysregulation of adipocytes, mitochondrial dysfunction, genetic factors, and changes in gut microbiota. Since insulin resistance is also a major predisposing factor of T2DM, the administration of anti-diabetic drugs for the management of NAFLD seems reasonable.In this review we provide the NAFLD-associated mechanisms of action of some of the most widely used anti-diabetic drugs, namely metformin, pioglitazone, sodium-glucose transport protein-2 inhibitors (SGLT2i), glucagon-like peptide 1 receptor analogs (GLP1 RAs), and dipeptyl-peptidase-4 inhibitors (DPP4i) and present available data regarding their use in patients with NAFLD, with and without T2DM.Both metformin and DPP4i have shown rather contradictory results, while pioglitazone seems to benefit patients with NASH and is thus the only drug approved for NASH with concomitant significant liver fibrosis by all major liver societies. On the other hand, SGLT2i and GLP1 RAs seem to be beneficiary in patients with NAFLD, showing both remarkable results, with SGLT2i proving to be more efficient in the only head-to-head study so far.In patients with NAFLD and diabetes, pioglitazone, GLP1 RAs, and SGLT2i seem to be logical treatment options. Larger studies are needed before these drugs can be recommended for non-diabetic individuals.© 2023. The Author(s).