非酒精性脂肪性肝病相关肝细胞癌的诊断和治疗

颜士岩; 范建高

doi:10.3969/j.issn.1001-5256.2021.08.002

非酒精性脂肪性肝病相关肝细胞癌的诊断和治疗

DOI: 10.3969/j.issn.1001-5256.2021.08.002

颜士岩,
范建高^,

上海交通大学附属新华医院消化内科，上海 200029

利益冲突声明：所有作者均声明不存在利益冲突。

作者贡献声明：颜士岩负责文献检索，撰写文章；范建高负责文章的整体指导、审核以及修改完善。

详细信息

通信作者:
范建高，fattyliver2004@126.com

中图分类号: R575.5;R735.7
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出版历程
- 收稿日期: 2021-05-28
- 录用日期: 2021-05-28
- 出版日期: 2021-08-20

Diagnosis and treatment of hepatocellular carcinoma associated with nonalcoholic fatty liver disease

Shiyan YAN,
Jiangao FAN^,

Department of Gastroenterology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200029, China

摘要

摘要: 全球大部分肝细胞癌(HCC)(＞80%)主要因HBV或HCV慢性感染导致。在中国，高达80%的HCC是由HBV引起，但目前HBV相关HCC死亡率降低了30%。与此同时，肥胖、2型糖尿病和非酒精性脂肪性肝病正在取代肝炎病毒和酒精滥用成为HCC的重要致病因素，代谢功能障碍及其相关脂肪性肝病导致的HCC近年来有不断增加趋势。为此需要重视非酒精性脂肪性肝病相关HCC的诊断、治疗并探讨其可能的发病机制。
- 非酒精性脂肪性肝病 /
- 癌, 肝细胞 /
- 诊断 /
- 治疗学
Abstract: At present, the majority (> 80%) of hepatocellular carcinoma (HCC) cases in the world is mainly caused by chronic HBV or HCV infection, and in China, up to 80% of HCC cases are caused by HBV, but the mortality rate of HBV-related HCC has decreased by 30% recently. At the same time, obesity, type 2 diabetes, and nonalcoholic fatty liver disease (NAFLD) gradually replace hepatitis virus infection and alcohol abuse and have become the important pathogenic factors for HCC, and there is also a tendency of increase in HCC cases caused by metabolic dysfunction and fatty liver disease in recent years. For this reason, it is particularly important to investigate the diagnosis, treatment, and possible pathogenesis of HCC associated with NAFLD.
- Non-Alcoholic Fatty Liver Disease /
- Carcinoma, Hepatocellular /
- Diagnosis /
- Therapeutics

HTML全文

图 1 HCC的BCLC分期系统

注：M，转移分类；N，淋巴结分类；PS，体能状态；TACE，肝动脉化疗栓塞术。

下载: 全尺寸图片幻灯片

图 2 第4版日本肝病学会肝细胞癌临床实践指南(第4版JSH-HCC指南)中HCC的治疗建议

注：1)在肝切除术的情况下，建议根据肝损伤进行评估；2)对于孤立性HCC，推荐切除作为一线治疗，消融作为二线治疗；3)仅Child-Pugh A级患者；4)年龄≤65岁的患者。HAIC，肝动脉灌注化疗；MTT，分子靶向治疗；TAE，经肝动脉栓塞术。

下载: 全尺寸图片幻灯片

表 1 NAFLD-HCC与其他原因引起的HCC患者的特征

特征	NAFLD-HCC	其他原因引起的HCC
主要发生性别	男性	男性
诊断时年龄(岁)	65~70	60~65
代谢综合征(%)	45~58	14~18
2型糖尿病(%)	54~74	12~49
肥胖(%)	48~66	12~37
高血压(%)	47~60	18~52
血脂异常(%)	28~35	6~14
肝硬化的发生率(%)	51~62	78~97
肝功能状况	大多数尚可	较差
平均肿瘤大小(cm)	≥3	≤3
肿瘤分化程度	高分化	高分化到中分化

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