《2009年EASL關于非酒精性脂肪性肝病研討會》內容預覽

Cirrhosis complications. Liver failure is often (30–51%) the first presentation of patients with cirrhotic NASH [60,61] and occurs after 7–10 years in 38–45% of cirrhotic cases [61,62] although available data, all retrospective, are subject to lead-time bias.Causes of death are liver failure, sepsis and variceal hemorrhage, or hepatocellular carcinoma (HCC) [60,61]. The latter is often diagnosed at a late stage [51,59,61,63], and may occasionally occur in non-cirrhotic NASH [64]. Obese or diabetic patients have an increased risk of HCC [65,66] even in association with otherchronic liver diseases [67,68]. Survival. Isolated steatosis does not increase overall or liver- related mortality [51,69]. Long-term follow-up studies have shown that NASH increases overall mortality by 35–85% com- pared to the age and sex-matched general population [51,70,71]. Liver-related mortality is increased 9–10-fold [51,71] with cirrhosis an independent cause of death ranking 3rd vs. 13th in the general population [22,70,71]. This has been confirmed in pediatric series. Cardiovascular mortality is increased two fold in NASH patients [51].

Liver transplantation. The proportion of patients with NASH among those undergoing liver transplantation has steadily increased over the recent past: from 0.1% between 1995 and 2000 to 3.5% in 2005 according to the UNOS database. Some of the patients with cryptogenic cirrhosis should be added to these: in one series one-third of these patients had histological signs of NASH on a detailed histological review of the graft [56]. If half of the patients with cryptogenic cirrhosis have burned-out NASH (based on histology and exposure to metabolic risk factors), then around 7% of liver transplants in the US are performed for NASH [72]. Importantly, this is an underestimate of the proportion of NASH progressing towards end-stage liver disease, as many patients are no longer listed for liver transplantation because of older age and associated comorbidities (mainly obesity, compli-cations of diabetes, or malignancies) (see Tables 2–5).

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