Etiological Evolution Of Liver Cirrhosis And Clinical Characteristics Of NAFLD-Related Cirrhosis

Objective:To explore the etiology and etiological trends of inpatients with liver cirrhosis in our hospital in the past ten years,compare the gender differences in etiology of cirrhosis,and explore the probability of different causes of developing hepatocellular carcinoma.So as to provide help for clinical diagnosis and treatment and disease prevention of liver cirrhosis.Methods:A collection of 1836 patients diagnosed with cirrhosis in the Department of Hepatology,Peking University of People’s Hospital from January 1,2010 to December 31,2019,among which patients who were hospitalized repeatedly were collected for the first time.There were 1326 cases included in the study eventually.Collect their clinical data such as demographic characteristics,causes,and complications,and analyze the constituent ratio and variation trend of various causes.Results:(1)Causes of liver cirrhosis:There are 434 cases of chronic hepatitis B,accounting for 32.7%;238 cases of alcoholic liver disease,accounting for 18%;136 cases of chronic hepatitis C,accounting for 10.3%;89 cases of chronic hepatitis B combined with alcoholic liver disease,accounting for 6.7%,33 cases of chronic hepatitis C combined with alcoholic liver disease,accounting for 2.5%;158 cases of autoimmune liver disease,accounting for 11.9%,of which primary biliary cholangitis(PBC)is the most common(8.1%),followed by autoimmune hepatitis(AIH)(1.9%);69 cases of chronic drug-induced liver damage accounting for 5.2%;32 cases of nonalcoholic fatty liver disease(NAFLD),accounting for 2.4%;97 cases of cryptogenic hepatitis,accounting for 7.3%.(2)Changes in the composition of main causes of liver cirrhosis:The proportion of chronic hepatitis B and C related cirrhosis showed a downward trend,from 45.5%in 2010 to 26.5%in 2019(p<0.001),from 16.1%in 2010 dropped to 9.0%in 2019(p<0.05);the proportions of alcoholic cirrhosis and NAFLD-related cirrhosis showed an upward trend,rising from 19.6%in 2010 to 31.2%in 2019(p<0.05),from 0%in 2010 to 5.3%in 2019(p<0.05)respectively.(3)Gender differences in etiology:male patients with alcoholic liver disease,chronic hepatitis B combined with alcoholic liver disease,and chronic hepatitis C combined with alcoholic liver disease accounted for higher proportions than women(28.2%vs.1.4%,10.5%vs.0.6%,3.8%vs.0.4%,p<0.01),while female patients with autoimmune liver disease,cryptogenic cirrhosis,and NAFLD-related cirrhosis were higher than male patients(3.4%vs.25.4%,3.4%vs.8.1%,0.9%vs.4.9%,p<0.001).(4)The probability of hepatocellular carcinoma complicated by different causes:chronic hepatitis B-related cirrhosis has the highest probability of hepatocellular carcinoma,accounting for 37.6%,followed by chronic hepatitis C-related cirrhosis 34.6%,and the probability of only alcoholic liver disease is 8.8%,but the probability of complicated hepatocarcinoma in alcoholic liver disease combined with HBV/HCV infection is significantly higher(29.2%,24.2%).The probability of hepatocarcinoma complicated by cryptogenic cirrhosis and NAFLD-related cirrhosis is 12.4%and 6.3%respectively.Conclusion:At present,the main cause of cirrhosis is still chronic hepatitis B,and the next is alcoholic liver disease.Chronic hepatitis B and C are on the decline,while alcoholic liver disease and NAFLD are on the rise.Chronic hepatitis B and alcoholic liver disease are mainly composed of male patients,while autoimmune liver disease and cryptogenic cirrhosis are mainly female.Viral hepatitis is the main cause of hepatocellular carcinoma.Objective : Compare the clinical characteristics of NAFLD-related cirrhosis with hepatitis B cirrhosis,hepatitis C cirrhosis,and alcoholic cirrhosis respectively,to explore the clinical characteristics of NAFLD-related cirrhosis in our hospital;and explore whether there are gender differences in clinical characteristics of NAFLD-related cirrhosis.Methods: Retrospectively analyze the clinical data of the four groups of liver cirrhosis who meet the inclusion and exclusion criteria,and record the demographic data such as age,gender and body mass index(BMI);laboratory indicators such as white blood cells,hemoglobin,platelets,prothrombin time,prothrombin time activity,and international normalized ratio,blood glucose,blood lipids,bilirubin,albumin,alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase,transpeptidase,creatinine,uric acid and so on;and clinical data such as complications and complications.And use the model for endstage liver disease(MELD)score to evaluate the prognosis,compare the differences between NAFLD-related ciirhosis and hepatitis B cirrhosis,NAFLD-related cirrhosis and hepatitis C cirrhosis,NAFLD-related cirrhosis and alcoholic cirrhosis respectively.At the same time,divide NAFLD-related cirrhosis into men and women to analyze the above clinical data and compai’e whether there were differences between gender.Results: 31 cases of NAFLD-related cirrhosis,400 cases of chronic hepatitis B cirrhosis,110 cases of chronic hepatitis C cirrhosis,and 174 cases of alcoholic cirrhosis were collected,respectively.The BMI of NAFLD-related cirrhosis was higher than that of the other three types of cirrhosis(/?<0.00!),and the probability of overweight,hypertension,and diabetes was higher than that of the other three types of cirrhosis(/?<0.05);the probability of hepatic encephalopathy was higher than that of viral hepatitis-related cirrhosis(p<0.05).Compared with chronic viral hepatitis-related cirrhosis,NAFLD-related cirrhosis has lower levels of transaminase and higher blood sugar levels.The levels of white blood cells,GGT and bilirubin in alcoholic cirrhosis were higher than those in NAFLD-related cirrhosis,and the difference was statistically significant(p<0.05).Compared with the MELD score of NAFLD-related cirrhosis,the MELD score of chronic hepatitis B cirrhosis was higher(p<0.05),that of alcoholic cirrhosis was lower 〇7<0.05)5 and that of chronic hepatitis C cirrhosis was not different from NAFLD-related cirrhosis(p=0.089).Conclusion: Compared with chronic hepatitis B cirrhosis,chronic hepatitis C cirrhosis,and alcoholic cirrhosis,patients with NAFLD-related cirrhosis have a higher BMI and a higher probability of overweight,diabetes,and hypertension.The probability of NAFLD-related cirrhosis complicated with hepatic encephalopathy is higher than that of chronic viral hepatitis-related cirrhosis,while the probability of primary liver cancer is lower than the latter.The prognosis of NAFLD-related cirrhosis is better than that of chronic hepatitis B cirrhosis,worse than that of alcoholic cirrhosis,and there is no difference compared with the prognosis of chronic hepatitis C cirrhosis.