FACTORES DE RIESGO EN LA ENFERMEDAD HEPATICA GRASA NO ALCOHOLICA




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FACTORES DE RIESGO EN LA ENFERMEDAD HEPATICA GRASA NO ALCOHOLICA

(especial para SIIC © Derechos reservados)
La enfermedad hepática grasa no alcohólica es una causa frecuente de hepatopatía crónica, con una prevalencia mundial creciente, que puede progresar a cirrosis y hepatocarcinoma.
alonsolopez9_62716.jpg Autor:
Sonia Alonso López
Columnista Experta de SIIC

Institución:
Hospital Universitario Fundación Alcorcón


Artículos publicados por Sonia Alonso López
Coautores
Conrado M Fernandez Rodriguez* María Luisa Gutiérrez García** 
Doctor en medicina, Hospital Universitario Fundacion Alcorcon, Madrid, España*
Doctora en medicina, Hospital Universitario Fundacion Alcorcon, Madrid, España**
Recepción del artículo
27 de Septiembre, 2015
Aprobación
20 de Abril, 2016
Primera edición
5 de Julio, 2016
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
La enfermedad hepática grasa no alcohólica puede afectar al 15%-25% de la población, con cifras mayores en pacientes obesos y con diabetes mellitus tipo 2. El principal factor de riesgo es el síndrome metabólico, especialmente la obesidad central. Aunque la mayoría de los pacientes con esteatosis macrovacuolar simple no presentan progresión de su enfermedad, existe un subgrupo que progresa a esteatohepatitis no alcohólica, y aunque se desconocen los factores de riesgo para esta progresión, la mayoría de los estudios reconocen la edad, la presencia de diabetes mellitas tipo 2 y la obesidad como predictores de riesgo independientes de EHNA. La presencia de lesión hepatocelular significativa, como el abalonamiento hepatocitario o la hialina de Mallory y la fibrosis, incrementan significativamente el riesgo de cirrosis. Los pacientes que tienen esta lesión histopatológica presentan una mortalidad de causa hepática superior, si bien no se ha demostrado una mortalidad global aumentada. Aunque la cirrosis secundaria a esteatohepatitis no alcohólica parece tener un pronóstico ligeramente mejor que la secundaria a hepatitis C, en muchas series es la tercera causa de trasplante ortotópico de hígado. La recurrencia postrasplante de la esteatosis, de la esteatohepatitis no alcohólica y de la cirrosis es frecuente. Existe un aumento del riesgo de hepatocarcinoma en pacientes con enfermedad hepática grasa no alcohólica. En la actualidad se recomienda el seguimiento para la detección precoz de este tumor en todos los pacientes con cirrosis criptogénica.

Palabras clave
enfermedad hepática grasa no alcohólica, hepatopatía crónica, esteatohepatitis no alcohólica, esteatosis hepática, cirrosis


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Abstract
Prevalence of non-alcoholic fatty liver disease (NAFLD) may be 10%-15% worldwide, and these figures are even higher in obese and in type 2 diabetes mellitus patients. The most important risk factor is metabolic syndrome, especially central obesity. Even though the majority of patients with macrovesicular steatohepatitis will not progress to advanced liver disease, a subgroup of patients will evolve to non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma. Independent risk factors associated with NASH are older age, type 2 diabetes mellitus and obesity. Patients with significant hepatocellular lesion, such as hepatocyte ballooning, Mallory hyalline or fibrosis, have a higher risk of cirrhosis and are more likely to have a high liver-related mortality, although higher global mortality has not been demonstrated. Although NASH related cirrhosis may have better prognosis compared to hepatitis C cirrhosis, recent series suggest that it may be the third cause of liver transplantation. Steatosis, NASH and cirrhosis recurrence post-liver transplantation is common. The risk of hepatocellular carcinoma (HCC) is increased in patients with NAFLD, and all patients with cryptogenic cirrhosis should be screened for HCC.

Key words
nonalcoholic steatohepatitis, hepatic steatosis, nonalcoholic fatty liver disease, chronic liver disease, cirrhosis


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Especialidades
Principal: Epidemiología, Gastroenterología
Relacionadas: Anatomía Patológica, Salud Pública



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Sonia Alonso López, HOSPITAL UNIVERSITARIO FUNDACION ALCORCON , 28922, Av. Budapest-1, Madrid, España
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