Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
J Gastroenterol. 2011 Jan;46 Suppl 1:63-9. doi: 10.1007/s00535-010-0311-8. Epub 2010 Sep 16.
We provide an update review on the prevalence, gender, ethnic variations, and prognosis of nonalcoholic steatohepatitis (NASH). According to annual health checks, 9-30% of Japanese adults have nonalcoholic fatty liver disease (NAFLD) by ultrasonography (US) and prevalence of NASH is estimated to be 1-3%. These conditions are strongly associated with the presence of obesity and lifestyle-related diseases. NAFLD and NASH exhibit age and gender differences in both prevalence and severity. Among younger patients, these conditions are more common in men (2-3 times); however, after 60 years of age, the prevalence of NASH is higher in women. According to a systemic analysis of histological findings for NASH, 37.6% of patients had progressive fibrosis, 20.8% improved, and 41.6% remained stable over a mean duration of follow-up of 5.3 years. Age and presence of inflammation on initial biopsy were independent predictors of progression to advanced fibrosis. The frequencies of development of cirrhosis in NASH are 5-25% during around 7-year follow-up periods. Survival in NASH is lower than the expected survival of the matched general population due to the higher prevalence of cardiovascular and liver-related death. In patients with cirrhotic NASH, hepatocellular carcinoma (HCC) and liver failure are the main causes of morbidity and mortality (5-year cumulative HCC development rate 11.3%, 5-year survival rate 75.2%, respectively). The cumulative rate of recurrence of HCC at 5 years was 72.5%. Regular screening for complications of liver cirrhosis and HCC is extremely important for cirrhotic NASH patients.
我们提供了一份关于非酒精性脂肪性肝炎（NASH）的流行率、性别、种族差异和预后的更新综述。根据年度健康检查，通过超声（US）检查，9-30%的日本成年人患有非酒精性脂肪性肝病（NAFLD），NASH 的患病率估计为 1-3%。这些疾病与肥胖和与生活方式相关的疾病密切相关。NAFLD 和 NASH 在患病率和严重程度上都存在年龄和性别差异。在年轻患者中，这些疾病在男性中更为常见（2-3 倍）；然而，在 60 岁以后，NASH 的患病率在女性中更高。根据对 NASH 组织学发现的系统分析，37.6%的患者存在进行性纤维化，20.8%改善，41.6%在平均 5.3 年的随访期间保持稳定。年龄和初始活检时的炎症是进展为晚期纤维化的独立预测因素。在大约 7 年的随访期间，NASH 发展为肝硬化的频率为 5-25%。由于心血管和肝脏相关死亡的患病率较高，NASH 的生存率低于匹配的一般人群的预期生存率。在患有肝硬化性 NASH 的患者中，肝细胞癌（HCC）和肝功能衰竭是发病率和死亡率的主要原因（5 年累积 HCC 发展率为 11.3%，5 年生存率为 75.2%）。5 年内 HCC 复发的累积率为 72.5%。对肝硬化和 HCC 并发症的定期筛查对肝硬化性 NASH 患者极为重要。
