Cryptogenic cirrhosis: Clinical characterization and risk factors for underlying disease
Cryptogenic cirrhosis: Clinical characterization and risk factors for underlying disease
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DOI：
10.1002/hep.510290347
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发表时间：
1999-03-01
期刊：
影响因子：
13.5
通讯作者：
Driscoll, CJ
中科院分区：
文献类型：
--
作者：
Caldwell, SH;Oelsner, DH;Driscoll, CJ
我们描述了70例连续的隐源性肝硬化患者，以评估肝病的主要风险。每名患者都重新评估了过去的酒精暴露，通过国际自身免疫性肝炎（IAH）评分进行评分，并评估了病毒性肝炎风险和非酒精性脂肪性肝炎（NASH）风险。将结果与50例连续NASH患者、39例年龄在50岁及以上的非酒精性丙型肝炎肝硬化患者和33例连续原发性胆汁性肝硬化（PBC）患者进行比较。在隐源性组中，49例（70%）为女性，平均年龄为63 ± 11岁。虽然腹水和静脉曲张出血是常见的，几乎一半缺乏复杂的门静脉高压症的主要体征。51例（73%）患者有2型糖尿病和/或肥胖史，19例（27%）患者在肝硬化诊断前有输血史，无临床或组织学特征将该组与其他患者区分开来，其中14例（74%）有肥胖和/或糖尿病史。其余19例未输血患者的IAH评分不确定，但在组织学和生化方面与其他患者无法区分。其中12人（63%）也有肥胖和/或糖尿病史。与PBC或丙型肝炎患者相比，隐源性黄疸患者中糖尿病和肥胖症的患病率明显更高。相比之下，肥胖和糖尿病的患病率与NASH患者相似，NASH患者平均年轻10岁。虽然有一些多样性表明不止一种原因，但我们的研究结果表明，NASH在许多隐源性肝硬化患者中起着未被充分认识的作用，其中大多数是老年人，2型糖尿病和肥胖女性。
We characterized 70 consecutive patients with cryptogenic cirrhosis to assess major risks for liver disease. Each patient was reevaluated for past alcohol exposure, scored by the International Autoimmune Hepatitis (IAH) score and assessed for viral hepatitis risks and risks for nonalcoholic steatohepatitis (NASH). The results were compared with 50 consecutive NASH patients, 39 nonalcoholic patients age SO and over with cirrhosis from hepatitis C, and 33 consecutive patients with cirrhosis caused by primary biliary cirrhosis (PBC), Among the cryptogenic group, 49 (70%) were female, and the mean age was 63 +/- 11 years. Although ascites and variceal bleeding were common, almost one half lacked major signs of complicated portal hypertension. A history of Type 2 diabetes mellitus and/or obesity was present in 51 (73%), Nineteen (27%) patients had a history of blood transfusions antedating the diagnosis of cirrhosis, No clinical or histological features distinguished this group from the other patients, and 14 (74%) of these had a history of obesity and/or diabetes. Nineteen of the remaining nontransfused patients had indeterminant IAH scores but were histologically and biochemically indistinguishable from the others. Twelve of these (63%) also had a history of obesity and/or diabetes. Both diabetes and obesity were significantly more common in the cryptogenic cirrhotic patients compared with the cirrhotic patients with PBC or hepatitis C, In contrast, the prevalence of obesity and diabetes was similar to the NASH patients who were, on average, a decade younger. Although there is some diversity that indicates more than one cause, our findings suggest that NASH plays an under-recognized role in many patients with cryptogenic cirrhosis, most of whom are older, type 2 diabetic and obese females.