Iron, hemochromatosis, and hepatocellular carcinoma
Iron, hemochromatosis, and hepatocellular carcinoma
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DOI：
10.1016/j.gastro.2004.09.019
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发表时间：
2004-11-01
期刊：
影响因子：
29.4
通讯作者：
Kowdley, KV
中科院分区：
文献类型：
--
作者：
Kowdley, KV
遗传性血色素沉着病 (HH) 与肝细胞癌 (HCC) 风险增加相关。此前估计风险增加了 200 倍。最近的研究表明，HFE 相关的 HH 发生 HCC 的风险可能要低得多，并且主要发生在诊断时患有肝硬化的患者中。非洲铁超负荷患者以及其他铁负荷疾病（例如纯合 0 地中海贫血）的患者患 HCC 的风险也会增加。在这些疾病中观察到的肝脏铁储存量大大增加，可以通过直接和间接途径刺激致癌作用。在接受肝移植的终末期肝病患者中，HCC 的患病率似乎也较高。目前尚不清楚肝脏铁储备轻度至中度增加或 HFE 突变是否与其他类型肝病患者患 HCC 风险增加独立相关。在本文中，讨论了 HH 和其他与铁超载相关的肝脏疾病患者中 HCC 的发病率和患病率，以及这些疾病中肝癌发生风险增加的可能机制。
Hereditary hemochromatosis (HH) is associated with an increased risk for hepatocellular carcinoma (HCC). The risk previously had been estimated to be as high as 200-fold increased. Recent studies suggest that the risk for HCC in HFE-associated HH may be much lower and occurs predominantly in patients with cirrhosis at the time of diagnosis. The risk for HCC also is increased among patients with African iron overload and possibly in other iron-loading disorders such as homozygous 0 thalassemia. The greatly increased iron stores in the liver observed in these disorders can stimulate carcinogenesis via both direct and indirect pathways. The prevalence of HCC also appears to be higher among patients with end-stage liver disease undergoing liver transplantation. It is not clear whether mildly to moderately increased hepatic iron stores or HFE mutations are associated independently with an increased risk for HCC among patients with other types of liver disease. In this article, the incidence and prevalence of HCC in patients with HH and other liver diseases associated with iron overload are discussed as well as the possible mechanisms for the increased risk for hepatic carcinogenesis in these disorders.