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发表于 2002-7-28 17:17
Gastroenterology 2002 Jul;123(1):134-140
Expanding the natural history of nonalcoholic steatohepatitis: From
cryptogenic cirrhosis to hepatocellular carcinoma.
Bugianesi E, Leone N, Vanni E, Marchesini G, Brunello F, Carucci P, Musso A,
De Paolis P, Capussotti L, Salizzoni M, Rizzetto M
Department of Gastroenterology, General Surgery Division, and Liver
Transplantation Unit, Ospedale S. Giovanni Battista, University of Turin;
General Surgery Division, Ospedale Mauriziano, Turin; and Unit of Metabolic
Diseases, Ospedale S. Orsola-Malpighi, University of Bologna, Bologna,
Italy.
[Record supplied by publisher]
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 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.
PMID: 12105842
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