BACKGROUND： Non-alcoholic fatty liver disease （NAFLD） is becoming a leading cause of chronic liver disease. Hepato- cellular carcinoma （HCC） is one of its complications. Although the pathophysiology is unclear, i...BACKGROUND： Non-alcoholic fatty liver disease （NAFLD） is becoming a leading cause of chronic liver disease. Hepato- cellular carcinoma （HCC） is one of its complications. Although the pathophysiology is unclear, it is reasonable to expect that cryptogenic cirrhosis related HCC （cryptogenic HCC） behaves differently to other types of HCC. This study prospectively compared patients with cryptogenic HCC and those with HCC related to alcoholic cirrhosis. METHODS： A total of 150 consecutive patients with HCC （89 cryptogenic HCC and 61 alcohol related HCC） referred to our unit over a 23-month period were studied. Their demographic data, liver function, tumor characteristics and outcomes were compared. RESULTS： Alcohol related HCC was seen only in males. Com- pared with cryptogenic HCC, alcohol related HCC had signifi- cantly higher aspartate aminotransferase/alanine aminotrans- ferase （AST/ALT） ratio （1.7 vs 1.4, P=0.002）, model for end- stage liver disease score （13 vs 11, P=0.018） and Child＇s score （7 vs 6, P=0.037）. No significant difference was seen in platelet counts, serum sodium and AST to platelet ratio index. Single nodular tumors were more common in cryptogenic HCC, while diffuse type tumors and macroscopic vascular invasion were common in alcohol related HCC. In patients who could not be offered any treatment because of advanced tumors or poor liver function, alcohol related HCC had a significantly lower median survival （5.3 months） compared with crypto- genic HCC （9.3 months, P=0.034）.CONCLUSIONS： Compared wtih cryptogenic HCC, alcohol related HCC had worse liver function and aggressive tumor morphology at presentation, and a higher proportion was untreatable. In patients who could not be treated, median sur- vival was lower in patients with alcohol related HCC than in those with cryptogenic HCC.展开更多
Non-alcoholic fatty liver disease(NAFLD)has become one of the most common chronic liver diseases worldwide.A strong relationship exists between NAFLD and diabetes mellitus.There is growing evidence of a mechanisticall...Non-alcoholic fatty liver disease(NAFLD)has become one of the most common chronic liver diseases worldwide.A strong relationship exists between NAFLD and diabetes mellitus.There is growing evidence of a mechanistically complex and strong association between the two diseases.Current data also shows that one disease actually leads to worsening of the other and vice versa.Understanding of the various pathophysiological mechanisms involved,natural history and spectrum of these two diseases is essential not only for early diagnosis and management but also for prevention of severe disease forms.Despite the tremendous progress made in recent times in acquiring knowledge about these highly prevalent diseases,the guidelines and recommendations for screening and management of diabetics with NAFLD remain ambiguous.An interdisciplinary approach is required to not only raise awareness of the prevalence of NAFLD in diabetics but also for better patient management.This can help attenuate the development of significant complications,such as cirrhosis,decompensation and hepatocellular carcinoma in these patients,thereby halting NAFLD in its tracks.This review focuses on the pivotal role of primary care physicians and endocrinologists in identification of NAFLD in diabetics in early stages and the role of proactive screening for prompt referral to hepatologist.展开更多
文摘BACKGROUND： Non-alcoholic fatty liver disease （NAFLD） is becoming a leading cause of chronic liver disease. Hepato- cellular carcinoma （HCC） is one of its complications. Although the pathophysiology is unclear, it is reasonable to expect that cryptogenic cirrhosis related HCC （cryptogenic HCC） behaves differently to other types of HCC. This study prospectively compared patients with cryptogenic HCC and those with HCC related to alcoholic cirrhosis. METHODS： A total of 150 consecutive patients with HCC （89 cryptogenic HCC and 61 alcohol related HCC） referred to our unit over a 23-month period were studied. Their demographic data, liver function, tumor characteristics and outcomes were compared. RESULTS： Alcohol related HCC was seen only in males. Com- pared with cryptogenic HCC, alcohol related HCC had signifi- cantly higher aspartate aminotransferase/alanine aminotrans- ferase （AST/ALT） ratio （1.7 vs 1.4, P=0.002）, model for end- stage liver disease score （13 vs 11, P=0.018） and Child＇s score （7 vs 6, P=0.037）. No significant difference was seen in platelet counts, serum sodium and AST to platelet ratio index. Single nodular tumors were more common in cryptogenic HCC, while diffuse type tumors and macroscopic vascular invasion were common in alcohol related HCC. In patients who could not be offered any treatment because of advanced tumors or poor liver function, alcohol related HCC had a significantly lower median survival （5.3 months） compared with crypto- genic HCC （9.3 months, P=0.034）.CONCLUSIONS： Compared wtih cryptogenic HCC, alcohol related HCC had worse liver function and aggressive tumor morphology at presentation, and a higher proportion was untreatable. In patients who could not be treated, median sur- vival was lower in patients with alcohol related HCC than in those with cryptogenic HCC.
文摘Non-alcoholic fatty liver disease(NAFLD)has become one of the most common chronic liver diseases worldwide.A strong relationship exists between NAFLD and diabetes mellitus.There is growing evidence of a mechanistically complex and strong association between the two diseases.Current data also shows that one disease actually leads to worsening of the other and vice versa.Understanding of the various pathophysiological mechanisms involved,natural history and spectrum of these two diseases is essential not only for early diagnosis and management but also for prevention of severe disease forms.Despite the tremendous progress made in recent times in acquiring knowledge about these highly prevalent diseases,the guidelines and recommendations for screening and management of diabetics with NAFLD remain ambiguous.An interdisciplinary approach is required to not only raise awareness of the prevalence of NAFLD in diabetics but also for better patient management.This can help attenuate the development of significant complications,such as cirrhosis,decompensation and hepatocellular carcinoma in these patients,thereby halting NAFLD in its tracks.This review focuses on the pivotal role of primary care physicians and endocrinologists in identification of NAFLD in diabetics in early stages and the role of proactive screening for prompt referral to hepatologist.
