高脂血症和非酒精性脂肪性肝炎对肝硬化无肝硬化发展的促

StephenW

J Clin Gastroenterol. 2018 Jun 16. doi: 10.1097/MCG.0000000000001062. [Epub ahead of print]
Hyperlipidemia and Nonalcoholic Steatohepatitis Predispose to Hepatocellular Carcinoma Development Without Cirrhosis.
Phan J1, Ng V1, Sheinbaum A2, French S1, Choi G1, El Kabany M1, Durazo F1, Saab S1, Tong M1, Busuttil R1, Han SH1,2.
Author information

1
    Pfleger Liver Institute, UCLA Medical Center.
2
    Greater Los Angeles VA Health Care System, Los Angeles, CA.

Abstract
BACKGROUND:

Hepatocellular carcinoma (HCC) accounts for 90% of primary hepatic malignancies. With the exception of chronic hepatitis B (CHB), other etiologies of chronic liver disease require progression to cirrhosis before HCC development. Case reports have described HCC in noncirrhotic patients with hepatitis C (HCV) and nonalcoholic fatty liver disease.
GOAL:

The aim of this study was to determine the prevalence of patients without cirrhosis and CHB who developed HCC among a large cohort of HCC patients and to identify independent variables that are associated with no cirrhosis among patients with HCC.
STUDY:

From 2005 to 2015, hepatobiliary cancer patients seen in our liver cancer and liver transplant clinics were evaluated. Patients were included if above18 years old and had histologically confirmed HCC from liver biopsy, resection specimen, or explanted livers. Patients with CHB, non-HCC tumors, or missing paired tumor and nontumor liver histology were excluded. Demographic information, pertinent laboratory values, and comorbid conditions were recorded. Potential predictors were evaluated using both backward stepwise logistic regression model and classification tree model.
RESULTS:

Of the 1927 patients screened, 545 HCC patients (411 transplanted, 43 resected, 74 transarterial chemoembolization/radiofrequency ablation, 17 untreated) included, 29 (5.3%) patients had no cirrhosis histologically. Eleven patients had HCV, 3 had alcoholic liver disease, 3 had nonalcoholic fatty liver, and 12 had cryptogenic liver disease. Logistic regression models show that patients with hyperlipidemia and elevated serum alanine aminotransferase are more likely to develop HCC without cirrhosis (odds ratio, 1.73 and 0.40; P<0.05).
CONCLUSIONS:

This large cohort, histology-confirmed case-controlled study shows that patients with nonalcoholic fatty liver disease and hyperlipidemia with elevated serum alanine aminotransferase (most likely nonalcoholic steatohepatitis) are significantly associated with the development of HCC in the absence of cirrhosis.

PMID:
    29912756
DOI:
    10.1097/MCG.0000000000001062

StephenW

J Clin Gastroenterol。 2018年6月16日。doi：10.1097 / MCG.0000000000001062。 [电子版提前打印]
高脂血症和非酒精性脂肪性肝炎对肝硬化无肝硬化发展的促进作用。
Phan J1，Ng V1，Sheinbaum A2，法国S1，Choi G1，El Kabany M1，Durazo F1，Saab S1，Tong M1，Busuttil R1，Han SH1,2。
作者信息

1
    Pfleger肝脏研究所，加州大学洛杉矶分校医学中心。
2
    大洛杉矶弗吉尼亚州医疗保健系统，洛杉矶，CA。

抽象
背景：

肝细胞癌（HCC）占原发性肝脏恶性肿瘤的90％。除慢性乙型肝炎（CHB）外，慢性肝病的其他病因学需要在HCC发展之前发展为肝硬化。病例报告描述了非肝硬化合并丙型肝炎（HCV）和非酒精性脂肪肝患者的HCC。
目标：

本研究的目的是确定无肝硬化患者和CHB患者在大量HCC患者中发生HCC的患病率，并确定HCC患者中与无肝硬化相关的独立变量。
研究：

从2005年到2015年，评估了在我们的肝癌和肝移植门诊中看到的肝胆癌患者。如果年龄在18岁以上，则包括患者，并且已经从肝活组织检查，切除标本或外植的肝脏组织学证实了HCC。排除CHB，非HCC肿瘤或缺失配对肿瘤和非肿瘤肝组织学的患者。记录人口统计信息，相关实验室数值和合并症状况。使用反向逐步逻辑回归模型和分类树模型评估潜在预测因子。
结果：

在筛选的1927例患者中，包括545例HCC患者（411例移植，43例切除，74例经动脉化疗栓塞/射频消融，17例未治疗），29例（5.3％）患者组织学无肝硬化。 HCV有11例，酒精性肝病3例，非酒精性脂肪肝3例，隐源性肝病12例。 Logistic回归模型显示，高脂血症和血清丙氨酸转氨酶升高的患者更容易发生HCC而无肝硬化（比值比1.73和0.40; P <0.05）。
结论：

这一大型组织学证实的病例对照研究显示，非酒精性脂肪性肝病和高血脂伴血清丙氨酸转氨酶升高（极可能是非酒精性脂肪性肝炎）的患者与无肝硬化的HCC发生显着相关。

结论：
    29912756
DOI：
    10.1097 / MCG.0000000000001062