Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan.
J Gastroenterol. 2010;45(1):86-94. doi: 10.1007/s00535-009-0128-5. Epub 2009 Sep 30.
Little is understood about worldwide changes in the epidemiological distribution of the etiology of liver cirrhosis (LC). The present study examines the etiology of liver cirrhosis in Japan using a nationwide survey.
We analyzed data from 33,379 patients with LC at 58 hospitals and presented the findings in a poster symposium regarding the etiology and clinical features of LC in Japan that was included in the program of the 44th Annual Meeting of the Japan Society of Hepatology. We identified the distribution of the etiology of LC and compared the present with previous Japanese findings to estimate the future of etiological changes in LC.
The etiological agents were as follows: hepatitis B virus (HBV) 13.9%, hepatitis C virus (HCV) 60.9%, alcohol 13.6%, primary biliary cirrhosis (PBC) 2.4% and autoimmune hepatitis (AIH) 1.9%. Cirrhosis was considered to be related to nonalcoholic steatohepatitis (NASH) in 2.1% of the patients. The ratio of HCV-related LC was significantly higher among patients with hepatocellular carcinoma (HCC) (P < 0.0001) compared to those without, whereas the ratios of alcohol, PBC, AIH were lower. HCC was evident in 31.5% of NASH-related LC.
The major etiology of liver cirrhosis in Japan remains HCV. Our survey revealed the prevalence of NASH-related LC in Japan and the frequency of HCC. Future changes in etiology must be considered in establishing preventive or educational strategies, as well as in developing new treatment strategies.
关于全球范围内肝硬化（LC）病因学的流行病学分布变化，人们知之甚少。本研究使用一项全国性调查，考察了日本 LC 的病因。
我们分析了 58 家医院的 33379 例 LC 患者的数据，并在日本 LC 的病因和临床特征海报研讨会上展示了研究结果，该研讨会被列入第 44 届日本肝脏研究学会年会的计划。我们确定了 LC 病因的分布，并将目前的情况与以前的日本发现进行了比较，以估计 LC 病因变化的未来。
病因如下：乙型肝炎病毒（HBV）13.9%、丙型肝炎病毒（HCV）60.9%、酒精 13.6%、原发性胆汁性肝硬化（PBC）2.4%和自身免疫性肝炎（AIH）1.9%。2.1%的患者认为肝硬化与非酒精性脂肪性肝炎（NASH）有关。在 HCC 患者中，HCV 相关 LC 的比例明显高于无 HCC 患者（P<0.0001），而酒精、PBC 和 AIH 的比例较低。NASH 相关 LC 中有 31.5%的患者有 HCC。
日本 LC 的主要病因仍然是 HCV。我们的调查揭示了日本 NASH 相关 LC 的流行情况和 HCC 的发生频率。在制定预防或教育策略以及开发新的治疗策略时，必须考虑病因的未来变化。
