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非酒精性脂肪性肝病相关肝细胞癌的诊断和治疗

颜士岩 范建高

颜士岩,范建高. 非酒精性脂肪性肝病相关肝细胞癌的诊断和治疗[J]. 临床肝胆病杂志, 2021, 37(8): 1748-1752. DOI: 10.3969/j.issn.1001-5256.2021.08.002
引用本文: 颜士岩,范建高. 非酒精性脂肪性肝病相关肝细胞癌的诊断和治疗[J]. 临床肝胆病杂志, 2021, 37(8): 1748-1752. DOI: 10.3969/j.issn.1001-5256.2021.08.002
YAN SY, FAN JG. Diagnosis and treatment of hepatocellular carcinoma associated with nonalcoholic fatty liver disease[J]. J Clin Hepatol, 2021, 37(8): 1748-1752. DOI: 10.3969/j.issn.1001-5256.2021.08.002
Citation: YAN SY, FAN JG. Diagnosis and treatment of hepatocellular carcinoma associated with nonalcoholic fatty liver disease[J]. J Clin Hepatol, 2021, 37(8): 1748-1752. DOI: 10.3969/j.issn.1001-5256.2021.08.002

非酒精性脂肪性肝病相关肝细胞癌的诊断和治疗

DOI: 10.3969/j.issn.1001-5256.2021.08.002
详细信息
    通讯作者:

    范建高,fattyliver2004@126.com

  • 中图分类号: R575.5;R735.7

Diagnosis and treatment of hepatocellular carcinoma associated with nonalcoholic fatty liver disease

  • 摘要: 全球大部分肝细胞癌(HCC)(>80%)主要因HBV或HCV慢性感染导致。在中国,高达80%的HCC是由HBV引起,但目前HBV相关HCC死亡率降低了30%。与此同时,肥胖、2型糖尿病和非酒精性脂肪性肝病正在取代肝炎病毒和酒精滥用成为HCC的重要致病因素,代谢功能障碍及其相关脂肪性肝病导致的HCC近年来有不断增加趋势。为此需要重视非酒精性脂肪性肝病相关HCC的诊断、治疗并探讨其可能的发病机制。

     

  • 图  1  HCC的BCLC分期系统

    注:M,转移分类;N,淋巴结分类;PS,体能状态;TACE,肝动脉化疗栓塞术。

    图  2  第4版日本肝病学会肝细胞癌临床实践指南(第4版JSH-HCC指南)中HCC的治疗建议

    注:1)在肝切除术的情况下,建议根据肝损伤进行评估;2)对于孤立性HCC,推荐切除作为一线治疗,消融作为二线治疗;3)仅Child-Pugh A级患者;4)年龄≤65岁的患者。HAIC,肝动脉灌注化疗;MTT,分子靶向治疗;TAE,经肝动脉栓塞术。

    表  1  NAFLD-HCC与其他原因引起的HCC患者的特征

    特征 NAFLD-HCC 其他原因引起的HCC
    主要发生性别 男性 男性
    诊断时年龄(岁) 65~70 60~65
    代谢综合征(%) 45~58 14~18
    2型糖尿病(%) 54~74 12~49
    肥胖(%) 48~66 12~37
    高血压(%) 47~60 18~52
    血脂异常(%) 28~35 6~14
    肝硬化的发生率(%) 51~62 78~97
    肝功能状况 大多数尚可 较差
    平均肿瘤大小(cm) ≥3 ≤3
    肿瘤分化程度 高分化 高分化到中分化
    下载: 导出CSV
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  • 收稿日期:  2021-05-28
  • 修回日期:  2021-05-28
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