Department of Internal Medicine, Division of Gastroenterology, Shinshu University School of Medicine, Matsumoto 390-8621, Japan.
Department of Metabolic Regulation, Shinshu University Graduate School of Medicine, Matsumoto 390-8621, Japan.
World J Gastroenterol. 2018 Apr 7;24(13):1440-1450. doi: 10.3748/wjg.v24.i13.1440.
The impact of mild drinking habit (less than 20 g/d of ethanol) on the clinical course of non-alcoholic fatty liver disease (NAFLD) has not been determined. We examined the influence of a mild drinking habit on liver carcinogenesis from NAFLD.
A total of 301 patients who had been diagnosed as having NAFLD by liver biopsy between 2003 and 2016 [median age: 56 years, 45% male, 56% with non-alcoholic steatohepatitis, 26% with advanced fibrosis (F3-4)] were divided into the mild drinking group with ethanol consumption of less than 20 g/d (mild drinking group, = 93) and the non-drinking group ( = 208). Clinicopathological features at the time of liver biopsy and factors related to hepatocellular carcinoma (HCC) occurrence were compared between the groups.
We observed significant differences in male prevalence ( = 0.01), platelet count ( = 0.04), and gamma-glutamyl transpeptidase ( = 0.02) between the test groups. Over 6 years of observation, the HCC appearance rate was significantly higher in the mild drinking group (6.5% 1.4%, = 0.02). Multivariate survival analysis using Cox's regression model revealed that hepatic advanced fibrosis (F3-4) ( < 0.01, risk ratio: 11.60), diabetes mellitus ( < 0.01, risk ratio: 89.50), and serum triglyceride ( = 0.04, risk ratio: 0.98) were factors significantly related to HCC in all NAFLD patients, while the effect of a drinking habit was marginal ( = 0.07, risk ratio: 4.43). In patients with advanced fibrosis (F3-4), however, a drinking habit ( = 0.04, risk ratio: 4.83), alpha-fetoprotein ( = 0.01, risk ratio: 1.23), and diabetes mellitus ( = 0.03, risk ratio: 12.00) were identified as significant contributors to HCC occurrence.
A mild drinking habit appears to be a risk factor for hepatocarcinogenesis in NAFLD patients, especially those with advanced fibrosis.
轻度饮酒习惯（每天乙醇摄入量＜20g）对非酒精性脂肪性肝病（NAFLD）临床病程的影响尚未确定。本研究旨在探讨轻度饮酒习惯对由 NAFLD 导致的肝癌发生的影响。
2003 年至 2016 年间，通过肝活检诊断为 NAFLD 的 301 例患者[中位年龄：56 岁，45%为男性，56%为非酒精性脂肪性肝炎，26%为晚期纤维化（F3-4）]，将其分为乙醇摄入量＜20g/d 的轻度饮酒组（轻度饮酒组，n=93）和非饮酒组（n=208）。比较两组患者肝活检时的临床病理特征及与肝细胞癌（HCC）发生相关的因素。
两组间男性患病率（P=0.01）、血小板计数（P=0.04）和γ-谷氨酰转肽酶（P=0.02）存在显著差异。在 6 年的观察期间，轻度饮酒组 HCC 发生率明显更高（6.5% vs. 1.4%，P=0.02）。多因素生存分析采用 Cox 回归模型显示，肝纤维化晚期（F3-4）（P＜0.01，风险比：11.60）、糖尿病（P＜0.01，风险比：89.50）和血清三酰甘油（P=0.04，风险比：0.98）是所有 NAFLD 患者 HCC 的显著相关因素，而饮酒习惯的影响具有边缘意义（P=0.07，风险比：4.43）。然而，在纤维化晚期（F3-4）的患者中，饮酒习惯（P=0.04，风险比：4.83）、甲胎蛋白（P=0.01，风险比：1.23）和糖尿病（P=0.03，风险比：12.00）是 HCC 发生的显著因素。
轻度饮酒习惯似乎是 NAFLD 患者发生肝癌的危险因素，尤其是纤维化晚期的患者。
