Clinicopathological correlations in a series of adult patients with non-alcoholic fatty liver disease
Clinicopathological correlations in a series of adult patients with non-alcoholic fatty liver disease
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DOI：
10.1111/j.1440-1827.2009.02489.x
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发表时间：
2010-02-01
影响因子：
2.2
通讯作者：
Hytiroglou, Prodromos
中科院分区：
文献类型：
--
作者：
Fotiadu, Anastasia;Gagalis, Asterios;Hytiroglou, Prodromos
对37例成人非酒精性脂肪性肝病(NAFLD)患者的临床资料、血清转氨酶水平和组织学特征之间的关系进行了研究，其中脂肪肝(FL)9例，非酒精性脂肪性肝炎(NASH)28例。在每一次肝活检中，确定NAFLD活动评分(NAS)和肝纤维化分期。此外，通过CD68抗原的免疫组织化学染色评估每厘米活检长度(MG/cm比率)中Kupffer细胞聚集体(微肉芽肿)的数量。明确的NASH与血清天冬氨酸氨基转移酶水平(P=0.003)、纤维化分期(P=0.003)、年龄(P=0.014)密切相关。多因素分析发现，年龄、46岁和AST水平高于正常值是NASH的独立临床预测因素。MG/cm比值从对照肝到FL再到NASH逐渐升高(P<；0.001)，并与NAS分期(P=0.003)和纤维化分期(P=0.004)相关，但与血清转氨酶水平无关。总之，可疑NAFLD患者持续的AST升高应作为肝脏活检的指征，以确定坏死炎性活动的严重程度和纤维化的分期。微小肉芽肿计数可能是NAFLD患者坏死炎性活动的有用补充标记物。
Possible correlations among clinical data, serum aminotransferase levels and histological features were assessed in a series of 37 adult patients with non-alcoholic fatty liver disease (NAFLD), consisting of nine patients with fatty liver (FL) and 28 with non-alcoholic steatohepatitis (NASH). In each liver biopsy, the NAFLD activity score (NAS) and the stage of fibrosis were determined. Additionally, the number of Kupffer cell aggregates (microgranulomas) per centimeter of biopsy length (MG/cm ratio) was assessed on immunohistochemical stains for CD68 antigen. Definite NASH (NAS >= 3 5) was strongly correlated with serum aspartate aminotransferase (AST) level (P = 0.003), stage of fibrosis (P = 0.003) and age (P = 0.014). On multivariate analysis, age > 46 years and AST level above normal values were found to be independent clinical predictors of established NASH. The MG/cm ratio increased from control liver to FL to NASH (P < 0.001), and was correlated with the NAS (P = 0.003) and with the stage of fibrosis (P = 0.004), but not with the serum aminotransferase levels. In conclusion, persistent AST elevation in patients with suspected NAFLD should be an indication for liver biopsy, in order to determine the severity of necroinflammatory activity and the stage of fibrosis. Microgranuloma counting may represent a useful complementary marker of necroinflammatory activity in patients with NAFLD.