Ahmad Muhammad Imran, Khan Muhammad Umair, Kodali Sudha, Shetty Akshay, Bell S Michelle, Victor David
Lynda K and David M Underwood Center for Digestive Disorders, Division of Gastroenterology and Hepatology, Houston Methodist Hospital Houston, Houston, TX, USA.
Department of Gastroenterology and Hepatology, Hamad Medical Corporation, Doha, Qatar.
J Hepatocell Carcinoma. 2022 Jun 1;9:477-496. doi: 10.2147/JHC.S344559. eCollection 2022.
Obesity has been labeled as the global pandemic of the 21st century, resulting from a sedentary lifestyle and caloric excess. Nonalcoholic fatty liver disease (NAFLD), characterized by excessive hepatic steatosis, is strongly associated with obesity and metabolic syndrome and is estimated to be present in one-quarter of the world population, making it the most common cause of the chronic liver disease (CLD). NAFLD spectrum varies from simple steatosis to nonalcoholic steatohepatitis (NASH) and cirrhosis. The burden of NAFLD has been predicted to increase in the coming decades resulting in increased rates of decompensated cirrhosis, hepatocellular carcinoma (HCC), and liver-related deaths. In the current review, we describe the pathophysiology of NAFLD and NASH, risk factors associated with disease progression, related complications, and mortality. Later, we have discussed the changing epidemiology of HCC, with NAFLD emerging as the most common cause of CLD and HCC. We have also addressed the risk factors of HCC development in the NAFLD population (including demographic, metabolic, genetic, dietary, and lifestyle factors), presentation of NAFLD-associated HCC, its prognosis, and the issue of HCC development in non-cirrhotic NAFLD. Lastly, the problems related to HCC screening in the NAFLD population, the remaining challenges, and future directions, especially the need to identify the high-risk individuals, will be discussed. We will conclude the review by summarizing the clinical evidence for treating fibrosis and preventing HCC in those at risk with NAFLD-associated HCC.
肥胖已被视为21世纪的全球性流行病，其成因是久坐不动的生活方式和热量摄入过多。非酒精性脂肪性肝病（NAFLD）以肝脏脂肪变性过多为特征，与肥胖和代谢综合征密切相关，据估计全球四分之一的人口患有该疾病，这使其成为慢性肝病（CLD）最常见的病因。NAFLD的范围从单纯性脂肪变性到非酒精性脂肪性肝炎（NASH）和肝硬化不等。预计在未来几十年中，NAFLD的负担将会增加，导致失代偿性肝硬化、肝细胞癌（HCC）和肝脏相关死亡的发生率上升。在本综述中，我们描述了NAFLD和NASH的病理生理学、与疾病进展相关的危险因素、相关并发症及死亡率。随后，我们讨论了HCC不断变化的流行病学，NAFLD已成为CLD和HCC最常见的病因。我们还阐述了NAFLD人群中HCC发生的危险因素（包括人口统计学、代谢、遗传、饮食和生活方式因素）、NAFLD相关HCC的表现、其预后以及非肝硬化性NAFLD中HCC发生的问题。最后，将讨论NAFLD人群中与HCC筛查相关的问题、尚存的挑战及未来方向，尤其是识别高危个体的必要性。我们将通过总结治疗纤维化和预防有NAFLD相关HCC风险者发生HCC的临床证据来结束本综述。
