Servicio de Gastroenterología, Hospital Clínico Universitario de Valladolid, Valladolid, España.
Servicio de Gastroenterología, Hospital Universitario Puerta de Hierro, Madrid, España.
Gastroenterol Hepatol. 2024 Apr;47(4):337-346. doi: 10.1016/j.gastrohep.2023.06.005. Epub 2023 Jun 19.
To describe in detail the epidemiology, diagnosis, clinical management, treatment options, impact on quality of life and unmet needs of patients with advanced liver fibrosis (F3-F4) associated with non-alcoholic steatohepatitis (NASH) in Spain.
Delphi study of two rounds of consultation rounds with 41 expert hepatologists from 16 autonomous communities to collect their experience in clinical practice.
The estimated prevalence of adult patients diagnosed with F3-F4 fibrosis associated with NASH in Spain is 0.019% (95% confidence interval [CI]: 0.019-0.020%). Approximately 7,588 adults with this condition are currently diagnosed and managed in the Digestive System Services of Spanish hospitals, and around 1,881 new patients are diagnosed each year. Management is multidisciplinary and includes the specialties of Digestive System, Endocrinology and Internal Medicine, considering the frequently associated metabolic comorbidities (obesity, type 2 diabetes mellitus or dysmetabolic iron overload). Despite a clear impact on quality of life, this it is not routinely evaluated in clinical practice. The most widely used non-invasive diagnostic techniques are transitional elastography and liver fibrosis index 4 (FIB-4). The absence of effective and safe treatments appears as the main unmet need for the management of these patients.
This study provides a representation of the current situation of patients diagnosed with F3-F4 fibrosis associated with NASH in Spain, increasing the evidence available and contributing to informed decision-making by professionals and the health system.
详细描述西班牙非酒精性脂肪性肝炎（NASH）相关晚期肝纤维化（F3-F4）患者的流行病学、诊断、临床管理、治疗选择、对生活质量的影响和未满足的需求。
对来自 16 个自治区的 41 名专家进行两轮德尔菲咨询，以收集他们在临床实践中的经验。
西班牙成年患者中诊断为 NASH 相关 F3-F4 纤维化的估计患病率为 0.019%（95%置信区间[CI]：0.019-0.020%）。目前，西班牙医院消化系统服务部门诊断和管理着约 7588 名患有这种疾病的成年人，每年约有 1881 名新患者被诊断出来。管理是多学科的，包括消化系统、内分泌学和内科，考虑到经常伴随的代谢合并症（肥胖、2 型糖尿病或代谢性铁过载）。尽管对生活质量有明显影响，但这在临床实践中并未得到常规评估。最广泛使用的非侵入性诊断技术是瞬时弹性成像和纤维化指数 4（FIB-4）。缺乏有效和安全的治疗方法似乎是这些患者管理的主要未满足需求。
本研究提供了西班牙诊断为 NASH 相关 F3-F4 纤维化患者的现状描述，增加了现有证据，并有助于专业人员和卫生系统做出明智决策。
