Comparison of hepatocellular carcinoma patients with alcoholic liver disease and nonalcoholic steatohepatitis
Comparison of hepatocellular carcinoma patients with alcoholic liver disease and nonalcoholic steatohepatitis
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DOI：
10.1097/01.alc.0000133547.70803.83
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发表时间：
2004-08-01
影响因子：
3.2
通讯作者：
Takasaki, K
中科院分区：
文献类型：
--
作者：
Hashimoto, E;Taniai, M;Takasaki, K
背景资料：酒精性肝炎和非酒精性脂肪性肝炎（NASH）表现出不同的临床特征，但肝脏组织学相似，但这两种疾病都可能进展为肝硬化和肝细胞癌（HCC）。在酒精性肝病（ALD）或NASH中出现HCC，而没有B或C型肝炎病毒感染，这是一种罕见的观察结果，并且没有研究比较ALD和NASH患者与HCC的特征。因此，我们比较ALD和NASH患者与HCC.Methods的特点：共1202例患者接受了诊断为HCC在东京女子医科大学从1989年至2003年，他们的临床资料进行了前瞻性收集。诊断ALD需要临床诊断，诊断NASH需要临床和组织学改变。在这些患者中，88例被诊断为ALD引起的HCC。其中，50例患者（ALD-HCC组）获得了活检标本。我们比较了50例ALD和8例NASH合并HCC患者（NASH-HCC组）的临床和组织学特征。结果：两组间差异最显著的是性别，两组间差异无显著性。女性在NASH-HCC组中明显更常见（6% vs. 63%; p < 0.0001）。ALD-HCC组的中位年龄为65岁，NASH-HCC组为68岁。NASH-HCC组中NASH的危险因素均较高。然而，这些组的肝功能检查结果相似。在ALD-HCC组中，46例（92%）患者显示严重纤维化; 2例有间隔纤维化，44例有肝硬化。NASH-HCC组中所有患者均表现为严重纤维化，7例有肝硬化。结论：严重纤维化可能是HCC的重要危险因素。患有ALD或NASH伴肝硬化的患者可能发展为HCC。这似乎发生在足够数量的情况下，以保证定期筛查这种并发症。
Background: Alcoholic hepatitis and nonalcoholic steatohepatitis (NASH) show different clinical features with similar liver histology, but both disorders may progress to cirrhosis and hepatocellular carcinoma (HCC). HCC arising in alcoholic liver disease (ALD) or NASH, without hepatitis B or C virus infection, has been a rare observation, and there are no studies comparing the characteristics of ALD and NASH patients with HCC. Therefore, we compared the characteristics of ALD and NASH patients with HCC.Methods: A total of 1202 patients received a diagnosis of HCC at Tokyo Women's Medical University from 1989 to 2003, and their clinical data were collected prospectively. A clinical diagnosis was made to diagnose ALD, and clinical and histological changes were required to diagnose NASH. Of these patients, 88 received a diagnosis of HCC arising from ALD. Among them, a biopsy specimen was obtained in 50 patients (ALD-HCC group). We compared the clinical and histological characteristics of 50 ALD and 8 NASH patients (NASH-HCC group) associated with HCC. They all were negative for hepatitis virus infection by serological methods.Results: The most significant difference between these groups was sex. Women were significantly more common in the NASH-HCC group (6% vs. 63%; p < 0.0001). The median age was 65 years in the ALD-HCC group and 68 years in the NASH-HCC group. The risk factors for NASH all were high in the NASH-HCC group. However, liver function tests were similar in these groups. In the ALD-HCC group, 46 (92%) patients showed severe fibrosis; 2 had septal fibrosis and 44 had cirrhosis. All patients in the NASH-HCC group showed severe fibrosis, and seven had cirrhosis.Conclusions: Severe fibrosis might be an important risk factor for HCC. Patients who have ALD or NASH with cirrhosis may develop HCC. This seems to occur in a sufficient number of cases to warrant regular screening for this complication.