Nonalcoholic steatohepatitis: a toxic liver disease in industrial workers
Nonalcoholic steatohepatitis: a toxic liver disease in industrial workers
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DOI：
10.1111/j.1478-3231.1999.tb00053.x
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发表时间：
1999-08-01
期刊：
影响因子：
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通讯作者：
Freitas, LAR
中科院分区：
文献类型：
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作者：
Cotrim, HP;Andrade, ZA;Freitas, LAR
目的：最近发现非酒精性脂肪性肝炎（NASH）与肝毒素的职业/环境暴露有关。本研究的目的是确定NASH的存在和频率在一个大的工人长期暴露于几个挥发性的石化产品在巴西东北部的工业区，并观察其过程中的工人从工作环境中删除。方法：1994 ~ 1995年对1500名无症状工人进行标准肝血检查。对3次转氨酶升高（> 3倍正常值）的患者进行临床和血清HBsAg、抗HCV、铁蛋白、脂质和自身抗体测定。无病因学诊断、HBsAg/抗HCV血清学阳性和/或过量饮酒的患者接受肝活检。排除肥胖、糖尿病或孤立性GGT异常的患者。在被诊断为NASH（组织学相容且无过量酒精摄入）的工人中，一部分人被从工作环境中移除，每月进行肝脏血液检查和8-14个月后的重复肝脏活检。结果：112名工人转氨酶异常，32名符合肝活检标准。其中20例被归类为NASH，其余为病毒性肝炎（n=6）、酒精性肝病（n=5）或门静脉血栓形成（n=1）。在所有10/20名脱离工作环境的人中，他们的转氨酶和GGT逐渐下降，组织学改善。结论：这些结果表明，NASH可以发生在工作场所长期暴露于挥发性石化物质。应定期筛查受暴露工人是否存在肝损伤，并尽可能将其从工作环境中移除。
Aims: Occupational/environmental exposure to hepatotoxins has recently been implicated in nonalcoholic steatohepatitis (NASH). The aims of this study were to determine the presence and frequency of NASH in a large group of workers chronically exposed to several volatile petrochemical products in an industrial area in north-east Brazil and to observe its course in workers removed from the work environment. Methods: 1500 asymptomatic workers were screened with standard liver blood tests during 1994-5. Those with elevated transaminases (>3x normal) on 3 occasions were evaluated further both clinically and with serum HBsAg, anti-HCV, ferritin, lipids and autoantibody determination. Patients with either no etiological diagnosis, positive HBsAg/anti-HCV serology and/or excess alcohol intake underwent liver biopsy. Those with obesity, diabetes or an isolated abnormal GGT were excluded. Of workers diagnosed as having NASH (compatible histology and no excess alcohol intake), a proportion were removed from the work environment and evaluated monthly with liver blood tests and a repeat liver biopsy 8-14 months later. Results: 112 workers had abnormal transaminases and 32 fulfilled the criteria for liver biopsy. 20 of these were classified as NASH, the remainder had viral hepatitis (n=6), alcoholic liver disease (n=5) or portal vein thrombosis (n=1). In all of the 10/20 who were removed from the work environment, their aminotransferases and GGT gradually decreased and their histology improved. Conclusions: These results demonstrate that NASH can occur following chronic exposure to volatile petrochemical substances in the workplace. Exposed workers should be regularly screened for the presence of liver damage and ideally removed from the work environment where possible.