Expanding the natural history from cryptogenic cirrhosis to of nonalcoholic steatohepatitis: Hepatocellular carcinoma
Expanding the natural history from cryptogenic cirrhosis to of nonalcoholic steatohepatitis: Hepatocellular carcinoma
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DOI：
10.1053/gast.2002.34168
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发表时间：
2002-07-01
期刊：
影响因子：
29.4
通讯作者：
Rizzetto, M
中科院分区：
文献类型：
--
作者：
Bugianesi, E;Leone, N;Rizzetto, M
背景和目标：非酒精性脂肪性肝炎（NASH）可能进展为肝硬化; NASH是否也在肝细胞癌（HCC）的发展中发挥作用尚不清楚。方法：在641例肝硬化患者中，我们回顾性地发现了44例隐源性肝硬化（CC）患者。其中，23例被积极随访，并与病毒和酒精相关的HCC进行了病例对照研究。比较两组间糖尿病、高血压、冠心病、血脂异常、肥胖的家族史和个人史及生化指标。铁的状态和存在突变的HFE基因的家族性血色病也进行了测定。结果：家族史与病因学无差异。肥胖和糖尿病的患病率在CC患者中显著较高。尽管肝功能相似，但CC患者的血糖、胆固醇和甘油三酯血浆水平较高，胰岛素抵抗参数增加，氨基转移酶水平较低。铁的状态和HFE基因突变的患病率没有差异。Logistic回归分析显示，高血脂、糖尿病和正常转氨酶是CC发生HCC的独立相关因素。结论：与明确的病毒或酒精病因的年龄和性别匹配的HCC患者相比，在CC患者发生的HCC中更常观察到提示NASH的特征。HCC可能是NASH相关肝硬化的晚期并发症。
Background & Aims: Nonalcoholic steatohepatitis (NASH) may progress to cirrhosis; whether NASH plays also a role in the development of hepatocellular carcinoma (HCC) is unknown. Methods: Among 641 cirrhosis-associated HCCs, we retrospectively identified 44 patients with cryptogenic cirrhosis (CC). Of these, 23 were actively followed up and were compared in a case-control study with viral- and alcohol-associated HCC. Family and personal history of diabetes, hypertension, coronary heart disease, dyslipidemia, obesity, and biochemical data were compared between groups. Iron status and presence of mutations in the HFE gene of familiar hemochromatosis were also determined. Results: Family history was not different in relation to etiology. The prevalence of obesity and diabetes was significantly higher in patients with CC. Although liver function was similar, CC patients had higher glucose, cholesterol, and triglyceride plasma levels, increased parameters of insulin resistance, and lower aminotransferase levels. Iron status and prevalence of a mutations in the HFE gene did not differ. Logistic regression analysis identified in sequence hypertriglyceridemia, diabetes, and normal aminotransferases as independent factors associated with HCC arising in CC. Conclusions: Features suggestive of NASH are more frequently observed in HCC arising in patients with CC than in age- and sex-matched HCC patients of well-defined viral or alcoholic etiology. HCC may represent a late complication of NASH-related cirrhosis.