川崎医学会誌39-2

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ケル憩室，Inflammatory fibroid tumor 各１例）に施行した．小腸カプセル内視鏡検査は，基礎疾患を有する高齢者に対しても安全に施行でき，病変検出率が高く，小腸疾患の診療に有用と考えられた．平成25年度川崎医学会賞　論文賞：総合内科学２　川中美和受賞対象論文：A prospective study showing poor prognosis in Japanese NASH patients with fibrosis stage F3-4川崎医学会誌/Kawasaki Med J 2012:38:119-127Abstract：Nonalcoholic fatty liver disease (NAFLD) is one of the most prevalent of all chronic liver diseases in Japan. The course and prognosis of disease in Japanese patients with NAFLD remains unclear. For a period of 5.2±2.4 years, we followed 274 Japanese patients with NAFLD who had undergone liver biopsy. The patients were divided into two groups: patients with simple steatosis (SS) or nonalcoholic steatohepatitis (NASH) with fibrosis Stages 0-2 (mildfibrosis group), and patients having NASH with fibrosis Stages 3-4 (advanced-fibrosis group). The course of hepatic disease and cerebro-cardiovascular events was evaluated in these two groups. Survival of the advanced-fibrosis group was lower than that of the mild-fibrosis group (p=0.001). In the advanced-fibrosis group, 7 patients (8.5%) experienced cerebro-cardiovascular events after diagnosis, and one died. Hepatic disease (9.8%) occurred in 8 patients: 4 with liver decompensation, 3 with hepatocellular carcinoma (HCC), and 1 with both liver decompensation and HCC. The 3patients with liver decompensation died; one underwent liver transplantation. No patient in the mild-fibrosis group experienced any cerebro-cardiovascular events or hepatic disease, and none of these patients died. The advanced-fibrosis group had higher values than the mild-fibrosis group for fibrosis marker, HOMA-IR, hemoglobin A1c, leptin, hs-CRP and lower platelet count, and had a tendency toward a higher incidence of diabetes mellitus and hypertension. It is important to understand how to diagnosis advance fibrosis NASH among so many patients with NAFLD.S79

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