肝硬化是一种发病和死亡的重要原因,是美国住院和死亡的第12大病因。[3]Davis GL, Roberts WL. The healthcare burden imposed by liver disease in aging Baby Boomers. Curr Gastroenterol Rep. 2010;12:1-6.http://www.ncbi.nlm.nih.gov/pubmed/20425478?tool=bestpractice.com在英国,肝硬化的死亡率从 1993 年的 6/100,000 增加到 2000 年的 12.7/100,000。[2]Ratib S, Fleming KM, Crooks CJ, et al. Causes of death in people with liver cirrhosis in England compared with the general population: a population-based cohort study. Am J Gastroenterol. 2015;110:1149-1158.http://www.ncbi.nlm.nih.gov/pubmed/26169512?tool=bestpractice.com由于许多肝病患者长期无症状,难以准确查明一般人群中肝硬化的患病率和发生率。
在美国,慢性病毒性肝炎、酒精性肝病和非酒精性脂肪性肝病 (non-alcoholic fatty liver disease, NAFLD) 占到肝病的绝大多数。[4]Kim WR, Brown RS Jr, Terrault NA, et al. Burden of liver disease in the United States: summary of a workshop. Hepatology. 2002;36:227-242.http://onlinelibrary.wiley.com/doi/10.1053/jhep.2002.34734/pdfhttp://www.ncbi.nlm.nih.gov/pubmed/12085369?tool=bestpractice.com在美国,丙肝病毒相关肝硬化患者是肝移植最常见的适应证,占因肝脏疾病死亡人数的40%,而丙肝病毒相关肝硬化患者的首要死因是肝细胞癌。[3]Davis GL, Roberts WL. The healthcare burden imposed by liver disease in aging Baby Boomers. Curr Gastroenterol Rep. 2010;12:1-6.http://www.ncbi.nlm.nih.gov/pubmed/20425478?tool=bestpractice.com事实上肝细胞癌占了肝脏疾病相关死亡的50%-70%。[5]Rustgi VK, Davis GL, Herrine SK, et al. Future trends in hepatology: challenges and opportunities. Hepatology. 2008;48:655-661.http://www.ncbi.nlm.nih.gov/pubmed/18666245?tool=bestpractice.com根据数学模型推测,与目前相比,至2020年失代偿性肝病和肝细胞癌的发生率加倍,而肝脏疾病相关死亡会增加近2倍。[6]Davis GL, Albright JE, Cook SF, et al. Projecting future complications of chronic hepatitis C in the United States. Liver Transpl. 2003;9:331-338.http://www.ncbi.nlm.nih.gov/pubmed/12682882?tool=bestpractice.com随着肥胖人群越来越多,NAFLD和非酒精性脂肪性肝炎 (non-alcoholic steatohepatitis, NASH) 的发生率不断增加。照此趋势,在21世纪,NAFLD将成为晚期肝病和肝衰竭的最常见病因。[3]Davis GL, Roberts WL. The healthcare burden imposed by liver disease in aging Baby Boomers. Curr Gastroenterol Rep. 2010;12:1-6.http://www.ncbi.nlm.nih.gov/pubmed/20425478?tool=bestpractice.com