Choudhuri Gourdas, Chaudhari Sujit, Pawar Dattatray, Roy Dyotona Sen
Vivekananda Poly Clinic and Institute of Medical Sciences, Lucknow, Uttar Pradesh; *Corresponding Author.
New Chaudhuri Diagnostic Gastroscopy, Kolkata, West Bengal; 3Abbott India Limited, Mumbai, Maharashtra.
J Assoc Physicians India. 2018 Dec;66(12):58-63.
Considering the paucity of relevant data for chronic liver disease (CLD) from India, this PAN-India study was conducted to assess the current etiologic spectrum of CLD, stage of liver fibrosis at presentation and the prescribing patterns of hepato-protective agents by gastroenterologists in Indian real-world setting. This data would aid in early detection and formulation of effective management strategies for CLD in India.
In this cross-sectional, multicentric, epidemiological study, consecutive patients (18 ≥ 65 years) diagnosed with CLD, assessed for liver fibrosis by Vibration Controlled Transient Elastography (VCTE), were evaluated for etiology by standard clinical and laboratory criteria and grouped in to alcoholic liver disease (ALD)/non-alcoholic fatty liver disease (NAFLD)/viral liver disease/ drug induced liver injury (DILI)/others. The doctors' prescription was studied in each case to note the pattern of hepatotropic medications prescribed, in addition to other specific agents.
Out of 504 enrolled patients with CLD (mean age: 47.9±11.81 years; men: 67.9%), 39.7% had NAFLD, 25.6% had ALD, 17.5% had hepatitis B (HBV), 7.9% had hepatitis C (HCV), 1.6% had autoimmune hepatitis, 0.4% had DILI and 7.3% had other causes of liver disease. Diabetes (15.9%), hypertension (12.9%), hypothyroidism (3.0%), dyslipidemia (1.2%) and obesity (0.4%) were the commonly reported comorbidities. Liver stiffness corresponding to the diagnosis of F4 liver fibrosis stage was reported in 77.5% HCV, 62.0% ALD, 46.0% NAFLD and 37.5% HBV patients. About 12.5% HCV, 8.0% NAFLD, 5.4% ALD, and 1.1% HBV patients reported F3 liver fibrosis stage. About 38.3% patients were on hepatoprotective drugs; commonly prescribed drugs were ademetionine (23.8%), ursodeoxycholic acid (17.9%) and drugs of herbal origin (11.3%).
NAFLD is emerging as a predominant etiology of CLD in India, followed by ALD, HBV, and HCV. However, significant regional differences regarding predominant etiology was noted within the country. It was further noted that significant number of patients had advanced fibrosis based on VCTE assessment. This study emphasizes the need for appropriate risk evaluation and early assessment of severity of liver disease, for adequate disease management.
鉴于来自印度的慢性肝病（CLD）相关数据匮乏，开展了这项全印度范围的研究，以评估CLD目前的病因谱、就诊时的肝纤维化阶段以及印度现实环境中胃肠病学家对肝保护剂的处方模式。这些数据将有助于印度CLD的早期检测和制定有效的管理策略。
在这项横断面、多中心的流行病学研究中，对连续诊断为CLD的患者（年龄≥18岁且≤65岁），通过振动控制瞬时弹性成像（VCTE）评估肝纤维化，并根据标准临床和实验室标准评估病因，分为酒精性肝病（ALD）/非酒精性脂肪性肝病（NAFLD）/病毒性肝病/药物性肝损伤（DILI）/其他。除其他特定药物外，还研究了每位医生的处方，以记录所开肝病药物的模式。
在504例纳入的CLD患者中（平均年龄：47.9±11.81岁；男性：67.9%），39.7%患有NAFLD，25.6%患有ALD，17.5%患有乙型肝炎（HBV），7.9%患有丙型肝炎（HCV），1.6%患有自身免疫性肝炎，0.4%患有DILI，7.3%患有其他肝病病因。常见的合并症有糖尿病（15.9%）、高血压（12.9%）、甲状腺功能减退（3.0%）、血脂异常（1.2%）和肥胖（0.4%）。在77.5%的HCV、62.0%的ALD、46.0%的NAFLD和37.5%的HBV患者中报告了符合F4肝纤维化阶段诊断的肝脏硬度。约12.5%的HCV、8.0%的NAFLD、5.4%的ALD和1.1%的HBV患者报告为F3肝纤维化阶段。约38.3%的患者正在使用肝保护药物；常用药物有腺苷蛋氨酸（23.8%）、熊去氧胆酸（17.9%）和草药来源的药物（11.3%）。
在印度，NAFLD正成为CLD的主要病因，其次是ALD、HBV和HCV。然而，该国在主要病因方面存在显著的地区差异。还进一步注意到，根据VCTE评估，相当数量的患者有晚期纤维化。本研究强调需要进行适当的风险评估和早期评估肝病严重程度，以进行充分的疾病管理。
