臨牀消化器内科 Vol.22 No.11(5)


特集名 NASH -- 最新の知見
題名 NASHの経過と予後
発刊年月 2007年 10月
著者 橋本 悦子 東京女子医科大学消化器病内科
【 要旨 】 NASH (nonalcoholic steatohepatitis) は，比較的新しい疾患概念であること，その診断に十分なコンセンサスが得られていないこと，病態が徐々に進行することより，その予後は，十分に解明されていない．NASHの予後に関する報告では，対象例がNAFLD (nonalcoholic fatty liver disease)，NASH，NASH肝硬変，さらには，burned-out NASHなどさまざまである．NASHでは5年で10 - 20%の症例が肝硬変に進行する．5年生存率は70 - 95%で，死因は肝関連死亡が10 - 30%を占める．NASH肝硬変では20 - 50%が肝不全症状を呈し，死因は70 - 80%が肝関連死である．NASH肝硬変の5年生存率は重症度によって異なり0 - 90%と報告されている．5年発癌率は0 - 20%で，NASH-HCCの特徴は高齢者で進行したNASHに発癌する．NASHの予後を明確にすることは，その経過観察，治療においてきわめて重要である．
Theme NASH : An Update
Title Natural History of NASH
Author Etsuko Hashimoto Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University
[ Summary ] The natural history of NASH remains poorly understood due to its intractable nature, the paucity of prospective studies and a lack of consensus regarding the various forms of this disorder. There have been several papers concerning the natural history of NAFLD, NASH, NASH with advanced fibrosis, cirrhotic NASH, and “burned-out” NASH. The rate of progression of cirrhosis in a 5 year period for NASH patients has been estimated to be 10 - 20%. The estimated five-year survival rate is 70 - 95% and 1O - 30% of the causes of death are liver related. Twenty to 50% of cirrhotic NASH patients have complications related to cirrhosis and 70 - 80% of the causes of death are liver related. The mortality rate for cirrhotic NASH depends on its severity. There is a 5-year estimated survival rate of 0 - 90%. The estimated five year rate of development for hepatocellular carcinoma is 0 - 20%. Risk factors for development of hepatocellular carcinoma include older age and advanced stage of the disease. Optimal management of NASH patients will require a clear understanding of the natural history of this disease. Therefore, more research is needed to clarify the natural history of NASH.
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