Progression from isolated steatosis to steatohepatitis and fibrosis in nonalcoholic fatty liver disease
Progression from isolated steatosis to steatohepatitis and fibrosis in nonalcoholic fatty liver disease
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DOI：
10.1016/j.gcb.2010.06.004
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发表时间：
2011-01-01
影响因子：
2.7
通讯作者：
Ratziu, V.
中科院分区：
文献类型：
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作者：
Pais, R.;Pascale, A.;Ratziu, V.
在非酒精性脂肪性肝病 (NAFLD) 患者中，孤立性脂肪变性被认为是一种良性病症，无进展或进展速度极慢，而非酒精性脂肪性肝炎 (NASH) 则可进展为肝硬化。我们报告了一系列六名患者在初次肝活检中出现孤立性脂肪变性，并在五年后进行的后续活检中出现 NASH。除一个初始活组织检查外，所有活组织检查的长度都超过 15 毫米。随访时，所有患者均出现炎症和气球样变，三名患者出现轻度纤维化。所有患者在基线时均具有一种或多种代谢综合征特征。脂肪性肝炎的进展与转氨酶的变化无关。随访期间，5 名患者的一种或多种代谢危险因素增加：体重指数、甘油三酯水平、动脉高血压和/或 HOMA 指数。一名患者没有表现出进展，但在随访结束时仍然暴露于代谢风险因素。该报告表明，孤立性脂肪变性不一定是良性、非进展性疾病。目前对于孤立性脂肪变性患者不进行肝脏监测的建议是不够的。如果代谢危险因素在随访期间持续存在或恶化和/或非侵入性标志物表明疾病进展，则应考虑进行对照肝活检。 (C) 2010 年由 Elsevier Masson SAS 出版。
In patients with nonalcoholic fatty liver disease (NAFLD) isolated steatosis is considered a benign condition with no or minimal rate of progression, in contrast to nonalcoholic steatohepatitis (NASH) which can progress to cirrhosis. We report on a series of six patients with isolated steatosis on an initial liver biopsy, and NASH on a follow-up biopsy performed five years after. All but one of the initial biopsies were longer than 15mm. At follow-up, inflammation and ballooning were present in all patients and mild fibrosis in three. All patients had one or more features of metabolic syndrome at baseline. Progression to steatohepatitis occurred independent of aminotransferase changes. Five patients experienced an increase in one or several metabolic risk factors during follow-up: body mass index, triglyceride levels, arterial hypertension and/or the HOMA index. One patient did not exhibit progression but was still exposed to metabolic risks factors at the end of follow-up. This report demonstrates that isolated steatosis is not necessarily a benign, non-progressive condition. Current recommendations for the absence of hepatic monitoring in patients with isolated steatosis are not adequate. If metabolic risk factors persist or deteriorate during follow-up and/or non-invasive markers suggest disease progression, a control liver biopsy should be considered. (C) 2010 Published by Elsevier Masson SAS.