| 特集名 | NASH 2018 | |
|---|---|---|
| 題名 | NASH診断のバイオマーカー | |
| 発刊年月 | 2018年 01月 | |
| 著者 | 角田 圭雄 | 愛知医科大学内科学講座肝胆膵内科学／日本医療戦略研究センター臨床研究・開発部Japan Study Group of NAFLD (JSG-NAFLD) |
| 著者 | 鎌田 佳宏 | 大阪大学大学院医学系研究科機能診断学／大阪大学大学院医学系研究科消化器内科学／日本医療戦略研究センター臨床研究・開発部Japan Study Group of NAFLD (JSG-NAFLD) |
| 著者 | 米田 正人 | 横浜市立大学肝胆膵消化器内科／日本医療戦略研究センター臨床研究・開発部Japan Study Group of NAFLD (JSG-NAFLD) |
| 著者 | 小野 正文 | 高知大学医学部消化器内科／日本医療戦略研究センター臨床研究・開発部Japan Study Group of NAFLD (JSG-NAFLD) |
| 著者 | 江口 有一郎 | 佐賀大学医学部肝疾患診療支援学／日本医療戦略研究センター臨床研究・開発部Japan Study Group of NAFLD (JSG-NAFLD) |
| 著者 | 米田 政志 | 愛知医科大学内科学講座肝胆膵内科学／日本医療戦略研究センター臨床研究・開発部Japan Study Group of NAFLD (JSG-NAFLD) |
| 【 要旨 】 | 世界中で成人の4人に1人が罹患するNAFLDの10～20％に肝疾患死亡リスクの高いNASHが存在する．NASH診断のゴールドスタンダードは肝生検であるが，サンプリングエラー，リスク，コストなど種々の課題があり，NAFLD全例に肝生検を施行することは非現実的である．NASHを予測するバイオマーカーの開発が急務であるが，近年は肝線維化が予後に関わるもっとも重要な因子であることが明らかになり，線維化進行例を拾い上げるシステムとしてNAFLD fibrosis scoreやFIB4 indexの有用性が確立されてきた．今後は，医療経済的合理性を念頭においた，予後，肝発癌，治療指標となる簡便で汎用性の高いパラメータの開発が求められる． | |
| Theme | NASH 2018 | |
|---|---|---|
| Title | Biomarkers for the Diagnosis of NASH | |
| Author | Yoshio Sumida | Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University / Japan Strategic Medical Administration Research Center, Division of Clinical Research and Development, Japan Study Group of NAFLD (JSG‒NAFLD) |
| Author | Yoshihiro Kamada | Departments of Molecular Biochemistry & Clinical Investigation, Osaka University, Graduate School of Medicine / Gastroenterology and Hepatology, Osaka University, Graduate School of Medicine / Japan Strategic Medical Administration Research Center, Di |
| Author | Masato Yoneda | Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine / Japan Strategic Medical Administration Research Center, Division of Clinical Research and Development, Japan Study Group of NAFLD (JSG‒NAFLD) |
| Author | Masafumi Ono | Department of Gastroenterology and Hepatology, Kochi Medical School / Japan Strategic Medical Administration Research Center, Division of Clinical Research and Development, Japan Study Group of NAFLD (JSG‒NAFLD) |
| Author | Yuichiro Eguchi | Liver Center, Saga University Hospital / Japan Strategic Medical Administration Research Center, Division of Clinical Research and Development, Japan Study Group of NAFLD (JSG‒NAFLD) |
| Author | Masashi Yoneda | Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University / Japan Strategic Medical Administration Research Center, Division of Clinical Research and Development, Japan Study Group of NAFLD (JSG‒NAFLD) |
| [ Summary ] | It is estimated that one fourth of the adult population is affected by nonalcoholic fatty liver disease (NAFLD) worldwide. Liver biopsy is the gold standard for diagnosing nonalcoholic steatohepatitis (NASH). NASH patients are at high risk of liver‒related mortality. However, liver biopsy also has many related problems, including sampling error, observers' variability, cost, and risk of complications. Moreover, it is not realistic to perform liver biopsy in every NAFLD patient. Although noninvasive diagnosis of NASH using various biomarkers has recently been attempted, it is rather important to predict the severity of hepatic fibrosis. The NAFLD fibrosis score and the FIB‒4 index are useful for excluding NASH with advanced fibrosis or predicting liver related mortality. It is required to predict over‒all mortality and hepatocarcinogenesis. | |