Azuma Seishin, Asahina Yasuhiro, Kakinuma Sei, Azuma Keiko, Miyoshi Masato, Inoue Emi, Tsunoda Tomoyuki, Sato Ayako, Kaneko Shun, Nagata Hiroko, Kawai-Kitahata Fukiko, Murakawa Miyako, Nitta Sayuri, Itsui Yasuhiro, Tomita Makoto, Nakagawa Mina, Watanabe Mamoru
Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Collaborative Medicine for Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan.
Dig Dis. 2019;37(3):247-254. doi: 10.1159/000493580. Epub 2019 Jan 9.
The risk factors associated with the development of hepatocellular carcinoma (HCC) in nonalcoholic fatty liver disease (NAFLD) are still unclear. The aim of the present study was to identify such risk factors in NAFLD patients who developed HCC.
Between April 2000 and -December 2016, a total of 182 patients with NAFLD were enrolled in this study; of these, only 22 patients had HCC. To identify risk factors, univariate and multivariate analyses were performed. To identify risk factors other than the degree of fibrosis, propensity matched analysis adjusted by the NAFLD fibrosis score (NFS) was carried out on 44 patients. Multivariate and survival analyses were also performed in HCC patients.
In 182 patients, multivariate analysis highlighted the NFS (OR 2.275; p < 0.001) and hypertension (OR 5.868; p = 0.037) as independent factors that were significantly associated with the development of HCC. After adjustment for the NFS, multivariate analysis identified diabetic retinopathy (OR 8.654; p = 0.017) as an independent factor that was significantly associated with the development of HCC. For predicting the development of HCC, the area under the receiver operating characteristic curve of diabetic retinopathy was significantly higher than that of diabetes (0.731 vs. 0.615; p < 0.001). In patients with HCC, multivariate analysis indicated that the NFS were significantly associated with diabetic retinopathy.
Diabetic retinopathy as well as liver fibrosis is a risk factor that associates with the development of HCC in NAFLD patients. Therefore, NAFLD patients with diabetic retinopathy should undergo careful screening for HCC.
非酒精性脂肪性肝病（NAFLD）中与肝细胞癌（HCC）发生相关的危险因素仍不明确。本研究的目的是在发生HCC的NAFLD患者中识别此类危险因素。
2000年4月至2016年12月期间，共有182例NAFLD患者纳入本研究；其中，仅有22例患者发生HCC。为识别危险因素，进行了单因素和多因素分析。为识别除纤维化程度之外的危险因素，对44例患者进行了经NAFLD纤维化评分（NFS）调整的倾向匹配分析。还对HCC患者进行了多因素和生存分析。
在182例患者中，多因素分析显示NFS（比值比[OR]2.275；P<0.001）和高血压（OR5.868；P=0.037）是与HCC发生显著相关的独立因素。在对NFS进行校正后，多因素分析确定糖尿病视网膜病变（OR8.654；P=0.017）是与HCC发生显著相关的独立因素。对于预测HCC的发生，糖尿病视网膜病变的受试者工作特征曲线下面积显著高于糖尿病（0.731对0.615；P<0.001）。在HCC患者中，多因素分析表明NFS与糖尿病视网膜病变显著相关。
糖尿病视网膜病变以及肝纤维化是NAFLD患者中与HCC发生相关的危险因素。因此，患有糖尿病视网膜病变的NAFLD患者应接受仔细的HCC筛查。
