The Impact of Obesity on Liver Histology
The Impact of Obesity on Liver Histology
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DOI：
10.1016/j.cld.2013.09.010
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发表时间：
2014-02-01
影响因子：
5.1
通讯作者：
Goodman, Zachary D.
中科院分区：
文献类型：
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作者：
Goodman, Zachary D.
肥胖和胰岛素抵抗导致肝脏在脂质代谢中的正常作用发生改变，导致肝脏活检中可识别的一系列变化。肝细胞脂肪空泡随着BMI增加而增加，产生脂肪变性。脂肪性肝炎发生时，也有细胞骨架损伤与角蛋白丝的损失，受影响的肝细胞气球样变和Mallory-Denk小体的形成。肝星状细胞的激活导致窦周隙纤维化。随着持续的纤维化，进展为桥接纤维化和肝硬化。肝细胞癌可能发生在脂肪肝，但肝细胞腺瘤和肝细胞癌都可能发生在脂肪肝前疾病。
Obesity and insulin resistance produce alterations in the liver's normal role in lipid metabolism resulting in a sequence of changes recognizable on liver biopsy. Hepatocellular fat vacuoles increase with BMI, producing steatosis. Steatohepatitis occurs when there is also cytoskeletal damage with loss of keratin filaments, ballooning of affected liver cells and formation of Mallory-Denk bodies. Activation of hepatic stellate cells produces fibrosis in the perisinusoidal spaces. With continuing fibrogenesis there is progression to bridging fibrosis and cirrhosis. Hepatocellular carcinoma may develop in the cirrhotic liver, but both hepatocellular adenoma and hepatocellular carcinoma may occur in pre-cirrhotic fatty liver disease.