非酒精性脂肪性肝炎与肝细胞癌相关性的统计学分析

发布时间：2018-04-08 10:15

本文选题：非酒精性脂肪性肝炎　切入点：肝细胞癌　出处：《大连医科大学》2014年硕士论文

【摘要】：背景：非酒精性脂肪性肝炎(nonalcoholic steatohepatitis，NASH)，是在本世界70年代由Peters等首次提出。在临床上，Ludwig等将NASH分为原发性和继发性。近年来，随着人们膳食结构的改变及生活水平的提高，糖尿病、肥胖的发病率在逐年增加，非酒精性脂肪性肝病（nonalcoholic fatty liver disease，NAFLD）的发病率也呈上升趋势，并逐渐成为危害人类健康的三大肝病之一。而NASH作为NAFLD的中间演化阶段，越来越引起人们的关注。随着NAFLD的病程进展，当肝组织出现气球样变性、腺泡点灶状坏死、门管区炎症或（伴）门管区周围炎症时，提示病变已由单纯性脂肪肝进展至NASH。当腺泡3带出现细胞周围／窦周纤维化，扩展到门管区及周围，出现局灶性或广泛的桥接纤维化时，提示NASH患者发生不同程度的肝纤维化，并且可进展至肝硬化，甚至有少数患者发生肝功能衰竭和肝细胞癌(hepatocellular carcinoma，HCC)。目前认为NAFLD／NASH可能己成为继慢性病毒性肝炎乙型（HBV）、慢性病毒性肝炎丙型（HCV）后引起原发性肝癌的另一个重要危险因素。目前在肝硬化基础上由NASH进展至肝癌人们已达成共识，而NASH，不经过肝硬化而诱发肝癌目前国际上有少量文献报道，NASH与肝细胞癌的关系，，目前尚无明确结论。目的：通过综合分析现有文献，证明NASH是否为HCC的危险因素。方法：分别“nonalcoholic steatohepatitis、fatty liver、liver cancer、NASH、hepatocellularcarcinoma、NASH and HCC、HCC、liver neoplasmas、nonalcoholic steatohepatitis andhepatocellular carcinoma、hepatom”为检索词，通过计算机检索Medline、OVID及PubMed数据库得到的1990至2013年发表的33篇文献中共416例NASH基础上发生肝癌患者的临床资料进行汇总分析。采用SPSS17.0统计软件对数据进行分析，对随访NASH患者中肝癌发生率与病毒性肝炎乙型患者5年肝癌发生率进行卡方检验。结果：（1）本研究纳入的416例NASH基础上发生HCC病例中不经过肝硬化而发生肝癌的占17.79％，经过肝硬化发生肝癌的占82.21％，提示不经过肝硬化NASH有发生HCC的可能；（2）随访研究中NASH患者肝癌发生率高达16.7％，甚至高于乙肝人群中肝癌发生率（4.4％），卡方检验二者比较有统计学意义（p=0.000）。（3）NASH基础上发生HCC的病例，诊断HCC的平均年龄为66.97岁，男性患者占59.43％，男女患者之比为1.46：1；提示NASH中老年男性为高危人群；(4)纳入的416例NASH基础上发生HCC患者中，伴有血脂异常的患者占27.76％，伴有肥胖的患者占67.61％，伴有高血压的患者占38.3％，伴有糖尿病的患者占59.13％，其中6.97％患者未列出上述情况，提示肥胖及糖尿病为主要的危险因素；(5)本研究收入不分病因的3409例肝癌患者中，在NASH基础上发生肝癌的占5.37％，是第3位致病因素；（6）多数患者在常规体检时发现HCC，可无任何症状。结论：NASH可能为HCC的危险因素。
[Abstract]:Background: nonalcoholic steatohepatitis was first proposed by Peters et al in the 1970s.Clinically, NASH is divided into primary and secondary by Ludwig et al.In recent years, with the change of dietary structure and the improvement of living standard, the incidence of diabetes and obesity is increasing year by year, and the incidence of nonalcoholic fatty liver disease (NAF LDD) is also on the rise.And gradually become one of the three major liver diseases endangering human health.As the intermediate stage of NAFLD evolution, NASH has attracted more and more attention.With the progression of NAFLD, balloon degeneration of liver tissue, focal necrosis of acinar point, inflammation of portal area or (with) inflammation around the hilar area indicate that the lesion has progressed from simple fatty liver to NASH.When acinar 3 band presents peri-cell / perisinusial fibrosis, extending to the hilar area and surrounding, focal or extensive bridging fibrosis occurs, which suggests that liver fibrosis occurs in patients with NASH to varying degrees, and may progress to cirrhosis.There are even a few patients with liver failure and hepatocellular carcinoma.It is believed that NAFLD/NASH may have become another important risk factor for primary liver cancer after chronic hepatitis B hepatitis B and chronic viral hepatitis C virus.At present, people have reached a consensus from NASH to HCC on the basis of liver cirrhosis. However, there are a few reports on the relationship between Nash and hepatocellular carcinoma in the world, and there is no clear conclusion about the relationship between Nash and hepatocellular carcinoma.Objective: to prove whether NASH is a risk factor for HCC by comprehensive analysis of existing literature.The data were analyzed by SPSS17.0 software. The incidence of liver cancer in patients with NASH and the incidence of liver cancer in patients with viral hepatitis B for 5 years were analyzed by chi-square test.Results in this study, 17.79% of the 416 cases of HCC developed on the basis of NASH without cirrhosis and 82.21% of cases of liver cancer developed through cirrhosis, suggesting that there is a possibility of HCC in patients without NASH.) in the follow-up study, NASH was found.The incidence of liver cancer in patients was as high as 16.7%, even higher than that in patients with hepatitis B (4.4%). The chi-square test showed that there were significant differences between the two groups in the incidence of HCC on the basis of 0.0000.000.The average age of diagnosis of HCC was 66.97 years old. The proportion of male patients was 59.43 and the ratio of male and female patients was 1.46: 1, indicating that the middle-aged and elderly men of NASH were high risk groups.Patients with dyslipidemia accounted for 27.76m, patients with obesity accounted for 67.61, patients with hypertension accounted for 38.3, patients with diabetes accounted for 59.13, and 6.97% of the patients did not list the above conditions.It is suggested that obesity and diabetes are the main risk factors in this study. Among the 3409 patients with liver cancer with no etiology, 5.37% of them developed liver cancer on the basis of NASH, and this is the third leading factor. Most of the patients found NASH on routine physical examination without any symptoms.Conclusion: Nash may be a risk factor for HCC.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575.5;R735.7

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