| セッション情報 |
International Forum 2(Liver) 1.Pathogenesis and Epidemiology
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| タイトル |
IF2-1-II (Keynote lecture) Nonalcoholic steatohepatitis and Hepatocellular carcinoma
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| 演者 |
Etsuko Hashimoto（Tokyo Women's Medical UniversityTokyoJapan） |
| 共同演者 |
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| 抄録 |
Recentlylifestyle－related diseases （metabolic syndrome） such as diabetes mellitushypertensionand hy－perlipidemia have become the leading public health problem because of the dramatic increase of these dis－eases in both Western countries and in Asia Nonalcoholic fatty liver disease （NAFLD） is a hepatic mani－festation of metabolic syndromeso NAFLD has now become a maj or liver disease in these countries． lnJapanannual health checks have begun to show 10－30% of adults being diagnosed as having NAFLD．Based on the prevalence of NAFLDthe prevalence of nonalcoholic steatohepatitis （NASH） is estimatedas 1－3%． This keynote lecture reviews important issues regarding NASH and hepatocellular carcinoma（HCC） ．An increased risk for HCC among people with obesity and diabetes mellitus has been well documented．Concerning NASHthe previQus case studies have shown that some patients develop HCC after the diag－nosis of NASHand suggest that most cases of HCC arise in the setting of NASH with cirrhosis． Growthfactors associated with chronic inflammationinsulin resistanceand DNA mutation as a result of lipid per－oxidation play significant roles in development of HCC． Evidence of progression from NASH to HCC inprospective studies is scant． We reported the natural history of NASH and showed that older age and ad－vanced fibrosis were significant risk factors for development of HCC． NASH shows a wide range of sever－ity from minimal fibrosis to cirrhosisso the 5－year cumulative incidence of HCC varied from O O／o to 20%according to the reports． Thenit is important to clarify the natural history of each stage in order to deter－mine how to manage these patients． NASH with mild fibrosis is generally considered a mild condition．Howeverthe previous studies confirmed thatalthough the morbidity and mortality of NASH cirrho＄iswere lower than those of hepatitis C cirrhosisboth followed a similar course with the onset of complica－tionsdevelopment of HCCand mortality． Occurrence of HCC was the strongest predictor of mortality．In conclusionregular screening for HCC is extremely important for NASH patients with advanced fibro－sis． |
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