本文選題：非酒精性脂肪性肝炎　切入點(diǎn)：肝細(xì)胞癌　出處：《大連醫(yī)科大學(xué)》2014年碩士論文

【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。在臨床上，Ludwig等將NASH分為原發(fā)性和繼發(fā)性。近年來，隨著人們膳食結(jié)構(gòu)的改變及生活水平的提高，糖尿病、肥胖的發(fā)病率在逐年增加，非酒精性脂肪性肝�。╪onalcoholic fatty liver disease，NAFLD）的發(fā)病率也呈上升趨勢，并逐漸成為危害人類健康的三大肝病之一。而NASH作為NAFLD的中間演化階段，越來越引起人們的關(guān)注。隨著NAFLD的病程進(jìn)展，當(dāng)肝組織出現(xiàn)氣球樣變性、腺泡點(diǎn)灶狀壞死、門管區(qū)炎癥或（伴）門管區(qū)周圍炎癥時(shí)，提示病變已由單純性脂肪肝進(jìn)展至NASH。當(dāng)腺泡3帶出現(xiàn)細(xì)胞周圍／竇周纖維化，擴(kuò)展到門管區(qū)及周圍，出現(xiàn)局灶性或廣泛的橋接纖維化時(shí)，提示NASH患者發(fā)生不同程度的肝纖維化，并且可進(jìn)展至肝硬化，甚至有少數(shù)患者發(fā)生肝功能衰竭和肝細(xì)胞癌(hepatocellular carcinoma，HCC)。目前認(rèn)為NAFLD／NASH可能己成為繼慢性病毒性肝炎乙型（HBV）、慢性病毒性肝炎丙型（HCV）后引起原發(fā)性肝癌的另一個(gè)重要危險(xiǎn)因素。目前在肝硬化基礎(chǔ)上由NASH進(jìn)展至肝癌人們已達(dá)成共識，而NASH，不經(jīng)過肝硬化而誘發(fā)肝癌目前國際上有少量文獻(xiàn)報(bào)道，NASH與肝細(xì)胞癌的關(guān)系，，目前尚無明確結(jié)論。 目的：通過綜合分析現(xiàn)有文獻(xiàn)，證明NASH是否為HCC的危險(xiǎn)因素。 方法：分別“nonalcoholic steatohepatitis、fatty liver、liver cancer、NASH、hepatocellularcarcinoma、NASH and HCC、HCC、liver neoplasmas、nonalcoholic steatohepatitis andhepatocellular carcinoma、hepatom”為檢索詞，通過計(jì)算機(jī)檢索Medline、OVID及PubMed數(shù)據(jù)庫得到的1990至2013年發(fā)表的33篇文獻(xiàn)中共416例NASH基礎(chǔ)上發(fā)生肝癌患者的臨床資料進(jìn)行匯總分析。采用SPSS17.0統(tǒng)計(jì)軟件對數(shù)據(jù)進(jìn)行分析，對隨訪NASH患者中肝癌發(fā)生率與病毒性肝炎乙型患者5年肝癌發(fā)生率進(jìn)行卡方檢驗(yàn)。 結(jié)果：（1）本研究納入的416例NASH基礎(chǔ)上發(fā)生HCC病例中不經(jīng)過肝硬化而發(fā)生肝癌的占17.79％，經(jīng)過肝硬化發(fā)生肝癌的占82.21％，提示不經(jīng)過肝硬化NASH有發(fā)生HCC的可能；（2）隨訪研究中NASH患者肝癌發(fā)生率高達(dá)16.7％，甚至高于乙肝人群中肝癌發(fā)生率（4.4％），卡方檢驗(yàn)二者比較有統(tǒng)計(jì)學(xué)意義（p=0.000）。（3）NASH基礎(chǔ)上發(fā)生HCC的病例，診斷HCC的平均年齡為66.97歲，男性患者占59.43％，男女患者之比為1.46：1；提示NASH中老年男性為高危人群；(4)納入的416例NASH基礎(chǔ)上發(fā)生HCC患者中，伴有血脂異常的患者占27.76％，伴有肥胖的患者占67.61％，伴有高血壓的患者占38.3％，伴有糖尿病的患者占59.13％，其中6.97％患者未列出上述情況，提示肥胖及糖尿病為主要的危險(xiǎn)因素；(5)本研究收入不分病因的3409例肝癌患者中，在NASH基礎(chǔ)上發(fā)生肝癌的占5.37％，是第3位致病因素；（6）多數(shù)患者在常規(guī)體檢時(shí)發(fā)現(xiàn)HCC，可無任何癥狀。結(jié)論：NASH可能為HCC的危險(xiǎn)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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R575.5;R735.7

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