Hussain Ahmed, Patel Preya J, Rhodes Freya, Srivastava Ankur, Patch David, Rosenberg William
UCL Institute for Liver and Digestive Health, London, UK.
UCL Institute for Liver and Digestive Health, London, UK
Clin Med (Lond). 2020 May;20(3):313-318. doi: 10.7861/clinmed.2019-0250.
Non-alcoholic fatty liver disease (NAFLD) accounts for 10-15% of orthotopic liver transplants (OLTs) in the UK. Index presentations with cirrhotic decompensation represent missed opportunities for preventive treatment leaving OLT or palliation as the only options.We retrospectively reviewed patient records for all NAFLD patients undergoing assessment for OLT between January 2003 and December 2017.Data were available for 81 patients with NAFLD as the primary diagnosis. Fifty-two patients had decompensated cirrhosis at first presentation; 91.7% presented to secondary care compared to 52.7% referred from primary care (p=0.001). Cirrhosis was not suspected at the time of referral to hospital in 24.7% of patients subsequently assessed for OLT. Most patients undergoing assessment for OLT for NAFLD had decompensated cirrhosis at their first diagnosis of chronic liver disease. These data highlight the plight of patients with NAFLD cirrhosis in whom chronic liver disease is diagnosed late.
非酒精性脂肪性肝病（NAFLD）占英国原位肝移植（OLT）的10%-15%。以肝硬化失代偿为首发表现意味着错过了预防性治疗的机会，使得肝移植或姑息治疗成为唯一选择。我们回顾性分析了2003年1月至2017年12月期间所有接受OLT评估的NAFLD患者的病历。有81例患者以NAFLD作为主要诊断，数据完整。52例患者初诊时即有肝硬化失代偿；91.7%就诊于二级医疗机构，而从初级医疗机构转诊而来的仅占52.7%（p=0.001）。在随后接受OLT评估的患者中，24.7%在转诊至医院时未被怀疑患有肝硬化。大多数因NAFLD接受OLT评估的患者在首次诊断为慢性肝病时就已出现肝硬化失代偿。这些数据凸显了NAFLD肝硬化患者慢性肝病诊断较晚的困境。
