The Natural History of Non-Alcoholic Fatty Liver Disease
The Natural History of Non-Alcoholic Fatty Liver Disease
复制标题
DOI：
10.1159/000282081
复制
发表时间：
2010-01-01
影响因子：
2.3
通讯作者：
Argo, Curtis
中科院分区：
文献类型：
--
作者：
Caldwell, Stephen;Argo, Curtis
非酒精性脂肪性肝病的预后是可变的，在一定程度上可以根据是否存在组织学肝损伤来预测。过去的研究已经确定了一些临床和实验室参数，这些参数预测了初始活检的严重程度，尽管所有这些措施都有局限性，活检仍然是目前的金标准。对于早期非酒精性脂肪性肝炎（NASH）患者，约三分之一将在5-10年内进展到3或4期（肝硬化）。因此，早期NASH是最有可能从目前正在研究的治疗中获益的人群之一。在进展为NASH肝硬化的患者中，约25%将在3年内发生门静脉高压症的主要并发症。相比之下，非NASH脂肪肝倾向于随时间推移而稳定，尽管在所有形式的脂肪肝中似乎都存在增加的癌症风险，尽管与非NASH脂肪肝相比，NASH脂肪肝中的癌症风险更大。有趣的是，NASH患者的死亡原因通常是心血管疾病或非肝脏恶性肿瘤，而不是肝硬化。然而，与心血管疾病相比，这一人群中肝硬化的风险加速，这表明这种情况在可预见的未来可能会改变。同时，这些合并症之间的关系将越来越多地导致冠心病或恶性肿瘤和NASH相关肝硬化患者在未来几年内给临床医生带来一系列非常具有挑战性的问题。版权所有（C）2010 S. Karger AG，巴塞尔
Non-alcoholic fatty liver disease has a variable prognosis which is predictable to an extent based on the presence or absence of histological liver injury. Past studies have determined a number of clinical and laboratory parameters which predict greater severity on the initial biopsy, although all of these measures have limitations and biopsy remains the gold standard at this time. For patients with early stage nonalcoholic steatohepatitis (NASH), about one third will progress to stage 3 or 4 (cirrhosis) over 5-10 years. Thus, early-stage NASH constitutes one of the groups most likely to benefit from treatments now undergoing investigation. Among those who progress to NASH cirrhosis, about 25% will develop major complications of portal hypertension within 3 years. In contrast, non-NASH fatty liver tends to be stable over time, although there appears to be an increased cancer risk in all forms of fatty liver, albeit greater in NASH compared to non-NASH fatty liver. Interestingly, the cause of death among patients with NASH is more often due to cardiovascular disease or non-liver malignancy than cirrhosis. However, the accelerated risk of cirrhosis in this group compared to cardiovascular disease suggests that this picture is likely to change in the foreseeable future. Meanwhile, the relationship between these comorbidities will increasingly lead to patients with both coronary disease or malignancy and NASH-related cirrhosis presenting clinicians with a very challenging set of problems in coming years. Copyright (C) 2010 S. Karger AG, Basel