Nonalcoholic steatohepatitis: A proposal for grading and staging the histological lesions
Nonalcoholic steatohepatitis: A proposal for grading and staging the histological lesions
复制标题
DOI：
10.1016/s0002-9270(99)00433-5
复制
发表时间：
1999-09-01
影响因子：
9.8
通讯作者：
Bacon, BR
中科院分区：
文献类型：
--
作者：
Brunt, EM;Janney, CG;Bacon, BR
目的：脂肪性肝炎是一种在酒精性或非酒精性肝病中可见的肝损伤形态。这种模式可能发生在肥胖、糖尿病、某些药物的使用，或者原因可能是特发性的。公认的非酒精性脂肪性肝炎（NASH）的组织病理学特征包括肝细胞脂肪变性和球囊样变，混合急慢性小叶炎症和3区肝窦周围纤维化。目前，对于各种其他形式的慢性肝病，还没有坏死炎症活动分级或纤维化分期的系统。本研究的目的是建立这样一个分级和分期系统，并基于对来自圣路易斯大学健康科学中心的51例非酒精性脂肪性肝炎患者的肝活检的回顾。方法：对10个活性组织学变量进行初步分析，确定分级；对轻度、中度和重度进行总体评价，并使用最重要的变量来确定坏死炎症的等级。结果：组织学病变被认为是显著的：脂肪变性，球囊，腺泡内和门静脉炎症。制定分期评分以反映纤维化的位置和程度。纤维化评分来源于3区窦周纤维化的程度，可能伴有门脉/门脉周围纤维化和建筑重构。纤维化分期如下：第1期，3区肝窦周围纤维化；第2期，同上，伴有门脉纤维化；第3期，同上，伴有桥性纤维化；第四阶段，肝硬化。结论：我们提出了一个反映非酒精性脂肪性肝炎独特组织学特征的分级和分期系统。[J]; journal of chengdu electromechanical college; 2004；(C) 1999 by Am。科尔。胃肠病学)。
OBJECTIVE: Steatohepatitis is a morphological pattern of liver injury that may be seen in alcoholic or nonalcoholic liver disease. This pattern may occur with obesity, diabetes, the use of certain drugs, or the cause may be idiopathic. The well-recognized histopathological features of nonalcoholic steatohepatitis (NASH) include hepatocellular steatosis and ballooning, mixed acute and chronic lobular inflammation, and zone 3 perisinusoidal fibrosis. Currently, there are no systems for grading necroinflammatory activity or for staging fibrosis as-exist for various other forms of chronic liver disease. The purpose of this study was to develop such a grading and:staging system and was based on review of liver biopsies-from 51 patients with nonalcoholic steatohepatitis from Saint Louis University Health Sciences Center.METHODS: For determination of grade, 10 histological variables of activity were initially analyzed; an overall impression of mild, moderate, and severe was made and the variables considered to be most significant were used to develop the necroinflammatory grade.RESULTS: The histological lesions considered to be significant were: steatosis, ballooning, and intra-acinar and portal inflammation. A staging score was developed to reflect both location and extent of fibrosis. The fibrosis score was derived from the extent of zone 3 perisinusoidal fibrosis with possible additional portal/periportal fibrosis and architectural remodeling. Fibrosis stages are as follows: Stage 1, zone 3 perisinusoidal fibrosis; Stage 2, as above with portal fibrosis; Stage 3, as above with bridging fibrosis; and Stage 4, cirrhosis.CONCLUSION: We propose a grading and staging system that reflects the unique histological features of nonalcoholic steatohepatitis.: (Am J Gastroenterol 1999;94:2467-2474. (C) 1999 by Am. Coll. of Gastroenterology).