一个新的威胁：非酒精性脂肪肝中的肝细胞癌

　　肝细胞癌是全世界范围内比较常见的肿瘤，在慢性HBV、HCV感染，饮酒、血色病相关的肝硬化基础上发展形成。最近，肝癌常与以肥胖和188bet在线平台网址 等代谢性疾病为主要表现的非酒精性肝病联系在一起。在发达国家，上述肥胖、代谢性疾病的高发病率和尤其是与肝癌的高发病率密切相关性，应引起我们注意。也有证据表明非酒精性脂肪性肝病与其它危险因素，如慢性丙肝和酒精性肝损伤存在协同作用。而且，这种相关性可能会将轻度或者无纤维化的非酒精性脂肪肝的病情复杂化，在一定程度上扩大了具有发展成肝癌危险性的患者群。相关的机制包括胰岛素抵抗和高胰岛素血症加强TNF信号通路和改变细胞脂质代谢过程。而这些机制相关研究为预防、早期识别和治疗非酒精性脂肪肝相关肝癌提供了新的靶点。实际上，二甲双胍和PPAR γ激动剂被认为减少危险性和改善肝癌患者预后。

　　吉林大学第一医院肝胆胰内科 金晶兰 摘译

　　本文首次发表于[J Hepatol, 2012, 56(6):1384-1391]

　　Hepatocellular carcinoma in non-alcoholic fatty liver disease:An emerging menace

Hepatocellular carcinoma (HCC) is a common cancer worldwide that primarily develops in cirrhosis resulting from chronic infection by hepatitis B virus and hepatitis C virus, alcoholic injury, and to a lesser extent from genetically determined disorders such as hemochromatosis. HCC has recently been linked to non-alcoholic fatty liver disease (NAFLD), the hepatic manifestation of obesity and related metabolic disorders such as diabetes. This association is alarming due to the globally high prevalence of these conditions and may contribute to the rising incidence of HCC witnessed in many industrialized countries. There is also evidence that NAFLD acts synergistically with other risk factors of HCC such as chronic hepatitis C and alcoholic liver injury. Moreover, HCC may complicate non-cirrhotic NAFLD with mild or absent fibrosis, greatly expanding the population potentially at higher risk. Major systemic and liver-specific molecular mechanisms involved include insulin resistance and hyperinsulinemia, increased TNF signaling pathways, and alterations in cellular lipid metabolism. These provide new targets for prevention, early recognition, and effective treatment of HCC associated with NAFLD.Indeed, both metformin and PPAR gamma agonists have been associated with lower risk and improved prognosis of HCC. This review summarizes current evidence as it pertains to the epidemiology, pathogenesis, and prevention of NAFLD-associated HCC.

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