亚太地区肝病流行病学的变化

StephenW

The changing epidemiology of liver diseases in the Asia–Pacific region

    Martin C. S. Wong, Jason L. W. Huang, Jacob George, Junjie Huang, Colette Leung, Mohammed Eslam, Henry L. Y. Chan & Siew C. Ng

Nature Reviews Gastroenterology & Hepatologyvolume 16, pages57–73 (2019) | Download Citation
Abstract

This Review presents current epidemiological trends of the most common liver diseases in Asia–Pacific countries. Hepatitis B virus (HBV) remains the primary cause of cirrhosis; despite declining prevalence in most Asian nations, this virus still poses a severe threat in some territories and regions. Mortality resulting from HBV infection is declining as a result of preventive measures and antiviral treatments. The epidemiological transition of hepatitis C virus (HCV) infection has varied in the region in the past few decades, but the medical burden of infection and the prevalence of its related cancers are increasing. The lack of licensed HCV vaccines highlights the need for novel treatment strategies. The prevalence of nonalcoholic fatty liver disease (NAFLD) has risen in the past decade, mostly owing to increasingly urbanized lifestyles and dietary changes. Alternative herbal medicine and dietary supplements are major causes of drug-induced liver injury (DILI) in some countries. Complications arising from these chronic liver diseases, including cirrhosis and liver cancer, are therefore emerging threats in the Asia–Pacific region. Key strategies to control these liver diseases include monitoring of at-risk populations, implementation of national guidelines and increasing public and physician awareness, in concert with improving access to health care.
Key points

    In the Asia–Pacific region, HBV, HCV, excessive alcohol consumption, the metabolic syndrome and concomitant liver diseases are the major factors resulting in chronic liver injury and end-stage liver pathology.

    The expanding implementation of HBV vaccination has been effective in reducing the incidence of liver cancer, especially in countries like China.

    Further effort is required to tackle the rising prevalence of HCV infection, for which a vaccine is not available.

    Nonalcoholic fatty liver disease (NAFLD) prevalence is increasing owing to increasingly urbanized lifestyles and dietary changes; as a result, the rising trend of NAFLD is becoming comparable to that of Western countries.

    As NAFLD is associated with the development of cardiovascular and kidney diseases, patients with this disease should receive tailor-made advice and continuous support for lifestyle modification.

    Liver cancer is prevalent, particularly in China, Vietnam, North Korea and Thailand.

StephenW

亚太地区肝病流行病学的变化

    Martin C. S. Wong，Jason L. W. Huang，Jacob George，黄俊杰，Colette Leung，Mohammed Eslam，Henry L. Y. Chan和Siew C. Ng

Nature Reviews Gastroenterology＆Hepatologyvolume 16，pages57-73（2019）|下载引文
抽象

本综述介绍了亚太国家最常见肝病的当前流行病学趋势。乙型肝炎病毒（HBV）仍然是肝硬化的主要原因;尽管大多数亚洲国家的流行率在下降，但这种病毒仍然在某些地区和地区构成严重威胁。由于预防措施和抗病毒治疗，HBV感染导致的死亡率下降。在过去几十年中，该地区丙型肝炎病毒（HCV）感染的流行病学转变有所不同，但感染的医疗负担和相关癌症的流行程度正在增加。缺乏获得许可的HCV疫苗突出了对新型治疗策略的需求。非酒精性脂肪性肝病（NAFLD）的流行在过去十年中有所增加，主要是由于日益城市化的生活方式和饮食变化。在一些国家，替代草药和膳食补充剂是药物性肝损伤（DILI）的主要原因。因此，这些慢性肝病（包括肝硬化和肝癌）引起的并发症正在亚太地区出现。控制这些肝脏疾病的关键策略包括监测高危人群，实施国家指南以及提高公众和医生的意识，以及改善获得医疗保健的机会。
关键点

    在亚太地区，HBV，HCV，过量饮酒，代谢综合征和伴随的肝脏疾病是导致慢性肝损伤和终末期肝病的主要因素。

    HBV疫苗接种的扩大实施有效降低了肝癌的发病率，特别是在中国这样的国家。

    需要进一步努力解决不能获得疫苗的HCV感染率上升的问题。

    由于日益城市化的生活方式和饮食变化，非酒精性脂肪性肝病（NAFLD）的患病率正在增加;因此，NAFLD的上升趋势正在与西方国家相媲美。

    由于NAFLD与心血管疾病和肾脏疾病的发展有关，患有这种疾病的患者应该获得量身定制的建议并不断支持改变生活方式。

    肝癌很普遍，特别是在中国，越南，朝鲜和泰国