アブストラクト
| Title | 肝硬変の治療 (抗ウイルス療法と栄養療法) |
|---|---|
| Subtitle | 今月のテーマ (総説) 新しい肝硬変診療 〜ガイドライン2020を紐解く〜 |
| Authors | 黒崎雅之1) |
| Authors (kana) | |
| Organization | 1)武蔵野赤十字病院消化器科 |
| Journal | 日本消化器病学会雑誌 |
| Volume | 118 |
| Number | 1 |
| Page | 22-29 |
| Year/Month | 2021 / 1 |
| Article | 報告 |
| Publisher | 日本消化器病学会 |
| Abstract | 要旨:肝硬変においてはエネルギー低栄養, 蛋白低栄養, サルコペニアが高頻度にみられ, これらは生存率を低下させる. 栄養状態を評価するとともに, 日本肝臓学会が提唱するサルコペニア判定基準に基づき筋量, 筋力を評価し, 栄養食事指導を行う. 肝硬変においては夜間の飢餓状態が高頻度にみられるため, 分割食, 就寝前軽食が推奨され, また不足している分岐鎖アミノ酸を含有食品・製剤などにより補充する治療介入が重要である. 肝硬変の成因の約50%はウイルス性肝炎である. B型肝硬変に対する核酸アナログ治療, C型肝硬変に対するDAA治療は, 肝線維化を改善し, 肝機能の増悪や非代償化を阻止し, 肝発癌を抑制して生命予後を改善する. |
| Practice | 臨床医学：内科系 |
| Keywords | 栄養評価, サルコペニア, B型肝炎, C型肝炎 |
- 全文ダウンロード： 従量制、基本料金制の方共に770円(税込) です。
参考文献
- 1) Enomoto H, Ueno Y, Hiasa Y, et al: Transition in the etiology of liver cirrhosis in Japan: a nation-wide survey. J Gastroenterol 55; 353-362: 2020
- 2) Plauth M, Bernal W, Dasarathy S, et al: ESPEN guideline on clinical nutrition in liver disease. Clin Nutr 38: 485-521: 2019
- 3) EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 70; 172-193: 2019
- 4) Shiraki M, Nishiguchi S, Saito M, et al: Nutritional status and quality of life in current patients with liver cirrhosis as assessed in 2007-2011. Hepatol Res 43; 106-112: 2013
- 5) Moriwaki H, Miwa Y, Tajika M, et al: Branched-chain amino acids as a protein-and energy-source in liver cirrhosis. Biochem Biophys Res Commun 313; 405-409: 2004
残りの66件を表示する
- 6) Hanai T, Shiraki M, Ohnishi ST et al: Rapid skeletal muscle wasting predicts worse survival in patients with liver cirrhosis. Hepatol Res 46; 743-751: 2016
- 7) Sinclair M, Gow PJ, Grossmann M, et al: Review articie: sarcopenia in cirrhosis--aetiology, implications and potential therapeutic interventions. Aliment Pharmacol Ther 43; 765-777: 2016
- 8) Nishikawa H, Yuri Y. Enomoto H, et al: Effect of psoas muscle mass after endoscopic therapy for patients with esophageal varices. Medicine 96: e6868: 2017
- 9) Takada H, Kurosaki M, Nakanishi H, et al: Impact of pre-sarcopenia in sorafenib treatment for advanced hepatocellular carcinoma. PLoS One 13: e0198812: 2018
- 10) Cruz-Jentoft AJ, Bahat G, Bauer J, et al: Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 48; 16-31: 2019
- 11) Chen LK, Liu LK, Woo J, et al: Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc 15; 95-101: 2014
- 12) Nishikawa H, Shiraki M, Hiramatsu A, et al: Japan Society of Hepatology guidelines for sarcopenia in liver disease (1st edition): Recommendation from the working group for creation of sarcopenia assessment criteria. Hepatol Res 46: 951-963: 2016
- 13) 日本消化器病学会, 日本肝臓学会: 肝硬変診療ガイドライン2020, 2020
- 14) Suzuki K, Endo R, Kohgo Y, et al: Guidelines on nutritional management in Japanese patients with liver cirrhosis from the perspective of preventing hepatocellular carcinoma. Hepatol Res 42: 621-626: 2012
- 15) Schneeweiss B, Graninger W, Ferenci P, et al: Energy metabolism in patients with acute and chronic liver disease. Hepatology 11; 387-393: 1990
- 16) Verboeket-van de Venne WP, Westerterp KR. van Hoek B, et al: Energy expenditure and substrate metabolism in patients with cirrhosis of the liver: effects of the pattern of food intake. Gut 36; 110-116: 1995
- 17) Guo YJ, Tian ZB, Jiang N, et al: Effects of Late Evening Snack on Cirrhotic Patients: A Systematic Review and Meta-Analysis. Gastroenterol Res Pract 2018; 9189062: 2018
- 18) Chen CJ, Wang LC. Kuo HT, et al: Significant effects of late evening snack on liver functions in patients with liver cirrhosis: A meta-analysis of randomized controlled trials. J Gastroenterol Hepatol 34: 1143-1152: 2019
- 19) Yamanaka-Okumura H, Nakamura T, Miyake H, et al: Effect of long-term late-evening snack on health-related quality of life in cirrhotic patients, Hepatol Res 40: 470-476: 2010
- 20) Hidaka H, Nakazawa T, Kutsukake S, et al: The efficacy of nocturnal administration of branched-chain amino acid granules to improve quality of Iife in patients with cirrhosis. J Gastroenterol 48; 269-276: 2013
- 21) Sorrentino P, Castaldo G, Tarantino L, et al: Preservation of nutritional-status in patients with refractory ascites due to hepatic cirrhosis who are undergoing repeated paracentesis. J Gastroenterol Hepatol 27; 813-822: 2012
- 22) Nakaya Y, Okita K, Suzuki K et al: BCAA-enriched snack improves nutritional state of cirrhosis. Nutrition 23; 113-120: 2007
- 23) Togo S, Tanaka K, Morioka D, et al: Usefulness of granular BCAA after hepatectomy for liver cancer complicated with liver cirrhosis. Nutrition 21; 480-486: 2005
- 24) Kawamura E, Habu D, Morikawa H, et al: A randomized pilot trial of oral branched-chain amino acids in early cirrhosis: validation using Prognostic markers for pre-liver transplant status. Liver Transpl 15: 790-797: 2009
- 25) Kobayashi M, Ikeda K, Arase Y, et al: Inhibitory effect of branched-chain amino acid granules on progression of compensated liver cirrhosis due to hepatitis C virus. J Gastroenterol 43; 63-70: 2008
- 26) Yoshida T, Muto Y, Moriwaki H, et al: Effect of long-term oral supplementation with branched-chain amino acid granules on the prognosis of liver cirrhosis. Gastroenterol Jpn 24; 692-698: 1989
- 27) Muto Y, Sato S, Watanabe A, et al: Effects of oral branched-chain amino acid granules on event-free survival in patients with liver cirrhosis. Clin Gastroenterol Hepatol 3: 705-713: 2005
- 28) Kitajima Y, Takahashi H, Akiyama T, et al: Supplementation with branched-chain amino acids ameliorates hypoalbuminemia, prevents sarcopenia, and reduces fat accumulation in the skeletal muscles of patients with liver cirrhosis. J Gastroenterol 53; 427-437: 2018
- 29) Hiraoka A, Michitaka K, Kiguchi D, et al: Efficacy of branched-chain amino acid supplementation and walking exercise for preventing sarcopenia in patients with liver cirrhosis. Eur J Gastroenterol Hepatol 29; 1416-1423: 2017
- 30) Hiraoka A, Izumoto H, Ueki H, et al: Easy surveillance of muscle volume decline in chronic liver disease patients using finger-circle (yubi-wakka) test. J Cachexia Sarcopenia Muscle 10; 347-354: 2019
- 31) Hayaishi S, Chung H, Kudo M, et al: Oral branched-chain amino acid granules reduce the incidence of hepatocellular carcinoma and improve event-free survival in patients with liver cirrhosis. Dig Dis 29: 326-332: 2011
- 32) Muto Y, Sato S, Watanabe A, et al: Overweight and obesitv increase the risk for liver cancer in patients with liver cirrhosis and long-term oral supplementation with branched-chain amino acid granules inhibits liver carcinogenesis in heavier patients with liver cirrhosis. Hepatoi Res 35: 204-214: 2006
- 33) Tada T, Kumada T, Toyoda H, et al: Oral supplementation with branched-chain amino acid granules prevents hepatocarcinogenesis in patients with hepatitis C-related cirrhosis: A propensity score analysis. Hepatol Res 44; 288-295: 2014
- 34) Kawaguchi T, Shiraishi K, Ito T, et al: Branched-chain amino acids prevent hepatocarcinogenesis and prolong survival of patients with cirrhosis. Clin Gastroenterol Hepatol 12; 1012-1018.e1: 2014
- 35) Gluud LL, Dam G, Borre M, et al: Oral branched-chain amino acids have a beneficial effect on manifestations of hepatic encephalopathy in a systematic review with meta-analyses of randomized controlled trials. J Nutr 143; 1263-1268: 2013
- 36) 日本肝臓学会肝炎診療ガイドライン作成委員会: B型肝炎治療ガイドライン(第3.2版). 2020. Available at: http://www.jsh.or.jp/medical/guidelines/jsh_guidlines/hepatitis_b
- 37) EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. 2017. Available at: https://easl.eu/publication/easl-guidelines-management-of-hepatitis-b/
- 38) Terrault NA, Lok ASF, McMahon BJ, et al: Up-date on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology 67; 1560-1599: 2018
- 39) Sarin SK, Kumar M, Lau GK, et al: Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatol Int 10: 1-98: 2016
- 40) Perrillo R, Tamburro C, Regenstein F, et al: Low-dose, titratable interferon alfa in decompensated liver disease caused bv chronic infection with hepatitis B virus. Gastroenterology 109; 908-916: 1995
- 41) Hoofnagle JH, Di Bisceglie AM, Waggoner JG, et al: Interferon alfa for patients with clinically apparent cirrhosis due to chronic hepatitis B. Gastroenterology 104; 1116-1121: 1993
- 42) Lange CM, Bojunga J, Hofmann WP, et al: Severe lactic acidosis during treatment of chronic hepatitis B with entecavir in patients with impaired liver function. Hepatology 50: 2001-2006: 2009
- 43) Dienstag JL. Goldin RD, Heathcote EJ, et al: Histological outcome during long-term lamivudine therapy. Gastroenterology 124; 105-117: 2003
- 44) Chang TT, Liaw YF, Wu SS, et al: Long-term entecavir therapy results in the reversal of fibrosis/cirrhosis and continued histological improvement in patients with chronic hepatitis B. Hepatology 52: 886-893: 2010
- 45) Marcellin P, Gane E, Buti M, et al: Regression of cirrhosis during treatment with tenofovir disoproxil fumarate for chronic hepatitis B: a 5-year open-label follow-up study. Lancet 381; 468-475: 2013
- 46) Liaw YF, Sumg JJ, Chow WC, et al: Lamivudine for patients with chronic hepatitis B and advanced liver disease. N Engl J Med 351; 1521-1531: 2004
- 47) Lok AS, McMahon BJ, Brown RS Jr, et al: Antiviral therapy for chronic hepatitis B viral infection in adults: A systematic review and meta-analysis. Hepatology 63; 284-306: 2016
- 48) Jang JW, Choi JY, Kim YS, et al: Long-term effect of antiviral therapy on disease course after decompensation in patients with hepatitis B virus related cirrhosis. Hepatology 61; 1809-1820: 2015
- 49) Shim JH, Lee HC, Kim KM, et al: Efficacy of entecavir in treatment-naive patients with hepatitis B virus-related decompensated cirrhosis. J Hepatol 52: 176-182: 2010
- 50) Lee sK, Song MJ, Kim SH. et al: Safety and efficacy of tenofovir in chronic hepatitis B-related decompensated cirrhosis. World J Gastroenterol 23: 2396-2403: 2017
- 51) Singal AK, Salameh H, Kuo YF, et al: Meta-analysis: the impact of oral anti-viral agents on the incidence of hepatocellular carcinoma in chronic hepatitis B. Aliment Pharmacol Ther 38; 98-106: 2013
- 52) Shiratori Y, Imazeki F, Moriyama M, et al: Histologic improvement of fibrosis in patients with hepatitis C who have sustained response to interferon therapy. Ann Intern Med 132; 517-524: 2000
- 53) Poynard T, McHutchison J, Manns M, et al: Impact of pegylated interferon alfa-2b and ribavirin on liver fibrosis in patients with chronic hepatitis C. Gastroenterology 122; 1303-1313: 2002
- 54) Maylin S, Martinot-Peignoux M, Moucari R, et al: Eradication of hepatitis C virus in patients successfully treated for chronic hepatitis C. Gastroenterology 135: 821-829: 2008
- 55) Kumada H, Suzuki Y, Ikeda K, et al: Daclatasvir plus asunaprevir for chronic HCV genotype 1b infection. Hepatology 59; 2083-2091: 2014
- 56) Mizokami M, Yokosuka O, Takehara T, et al: Ledipasvir and sofosbuvir fixed-dose combination with and without ribavirin for 12 weeks in treatment-naive and previously treated Japanese patients with genotype 1 hepatitis C: an open-labe!, randomised, phase 3 trial. Lancet Infect Dis 15; 645-653: 2015
- 57) Kumada H, Watanabe T, Suzuki F, et al: Efficacy and safety of glecaprevir/pibrentasvir in HCV-infected Japanese patients with prior DAA experience. severe renal impairment, or genotype 3 infection. J Gastroenterol 53; 566-575: 2018
- 58) Chayama K, Suzuki F, Karino Y, et al: Efficacy and safety of glecaprevir/pibrentasvir in Japanese patients with chronic genotype 1 hepatitis C virus infection with and without cirrhosis. J Gastroenterol 53; 557-565: 2018
- 59) Omata M, Nishiguchi S, Ueno Y, et al: Sofosbuvir plus ribavirin in Japanese patients with chronic genotype 2 HCV infection: an open-label, phase 3 trial. J Viral Hepat 21: 762-768: 2014
- 60) Kumada H. Suzuki Y, Karino Y, et al: The combination of elbasvir and grazoprevir for the treatment of chronic HCV infection in Japanese patients: a randomized phase II/III study. J Gastroenterol 52: 520-533: 2017
- 61) Toyoda H, Chayama K, Suzuki F, et al: Efficacy and safety of glecaprevir/pibrentasvir in Japanese patients with chronic genotype 2 hepatitis C virus infection. Hepatology 67: 505-513: 2018
- 62) Izumi N, Takehara T. Chayama K, et al: Sofosbuvir-velpatasvir plus ribavirin in Japanese patients with genotype 1 or 2 hepatitis C who failed direct-acting antivirals. Hepatol Int 12: 356-367: 2018
- 63) Singh S, Facciorusso A, Loomba R, et al: Magnitude and Kinetics of Decrease in Liver Stiffness After Antiviral Therapy in Patients With Chronic Hepatitis C: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 16; 27-38.e4: 2018
- 64) Mandorfer M, Kozbial K, Schwabl P, et al: Sustained virologic response to interferon-free therapics ameliorates HCV-induced portal hypertension. J Hepatol 65; 692-699: 2016
- 65) Di Marco V, Calvaruso V, Ferraro D, et al: Effects of Eradicating Hepatitis C Virus Infection in Patients With Cirrhosis Differ With Stage of Portal Hypertension. Gastroenterology 151; 130-139.e2: 2016
- 66) Li DK, Ren Y, Fierer DS, et al: The short-term incidence of hepatocellular carcinoma is not increased after hepatitis C treatment with direct-acting antivirals: An ERCHIVES study. Hepatology 67: 2244-2253: 2018
- 67) Nagata H, Nakagawa M, Asahina Y, et al; Effect of interferon-based and -free therapy on early occurrence and recurrence of hepatocellular carcinoma in chronic hepatitis C. J Hepatol 67; 933-939: 2017
- 68) Carrat F, Fontaine H, Dorival C, et al: Clinical outcomes in patients with chronic hepatitis C after direct-acting antiviral treatment: a prospective cohort study. Lancet 393: 1453-1464: 2019
- 69) Asahina Y: JSH Guidelines for the Management of Hepatitis C Virus Infection, 2019 Update; Protective Effect of Antiviral Therapy against Hepatocarcinogenesis. Hepatol Res 50; 775-790: 2020
- 70) Takahara T, Sakamoto N. Nishiguchi S, et al: Efficacy and safety of sofosbuvir-velpatasvir with or without ribavirin in HCV-infected Japanese patients with decompensated cirrhosis: an open-label phase 3 trial. J Gastroenterol 54; 87-95: 2019
- 71) 日本肝臓学会肝炎診療ガイドライン作成委員会: C型肝炎治療ガイドライン(第8版). 2020. Available at: http://www.jsh.or.jp/medical/guidelines/jsh_guidlines/hepatitis_c
