Nonalcoholic fatty liver disease: A spectrum of clinical and pathological severity
Nonalcoholic fatty liver disease: A spectrum of clinical and pathological severity
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DOI：
10.1016/s0016-5085(99)70506-8
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发表时间：
1999-06-01
期刊：
影响因子：
29.4
通讯作者：
McCullough, AJ
中科院分区：
文献类型：
--
作者：
Matteoni, CA;Younossi, ZM;McCullough, AJ
背景与目的：非酒精性脂肪性肝病的范围从单独的脂肪肝到非酒精性脂肪性肝炎。大多数以往的研究随访时间较短，在确定临床结果时没有仔细描述不同的组织学类型。本研究的目的是比较不同类型非酒精性脂肪肝患者的临床特征和预后。方法：对1979年至1987年所有脂肪堆积的肝活检标本进行炎症、球囊变性、Mallory透明样变和纤维化评估。活检标本也被评估组织铁和丙型肝炎RNA。结果是肝硬化、死亡率和肝脏相关死亡率。结果：772例肝活检标本中，132例获得完整资料。脂肪肝（1型）与其他三种类型的合并在性别、种族、年龄或肥胖方面没有区别。肝硬化在其他类型合并（22%）中比单独脂肪肝（4%;P < 0.001）更常见。总体死亡率、组织学铁和丙型肝炎在两组之间没有差异。大多数与肝脏相关的死亡是4型。结论：肝硬化和肝脏相关死亡的结局在非酒精性脂肪肝中并不统一。这些不良结果在活检显示球囊变性和马洛里透明或纤维化的患者中更为常见。
Background & Aims: The spectrum of nonalcoholic fatty fiver disease ranges from fatty liver alone to nonalcoholic steatohepatitis. Most previous studies have short follow-up and have not carefully delineated different histological types when determining clinical outcomes. The aim of this study was to compare clinical characteristics and outcomes of patients with different types of nonalcoholic fatty liver. Methods: All liver biopsy specimens from 1979 to 1987 with fat accumulation were assessed for inflammation, ballooning degeneration, Mallory hyaline, and fibrosis. Biopsy specimens were also assessed for histological iron and hepatitis C RNA. Outcomes were cirrhosis, mortality, and liver-related mortality. Results: Of 772 liver biopsy specimens, complete data were available in 132 patients. Fatty liver (type 1) did not differ from the other three types combined with respect to gender, race, age, or obesity. Cirrhosis was more common in the other types combined (22%) than fatty liver alone (4%; P < 0.001). Overall mortality, histological iron, and hepatitis C did not differ between groups. Most of the liver-related deaths were in type 4. Conclusions: The outcome of cirrhosis and liver-related death is not uniform across the spectrum of nonalcoholic fatty liver. These poor outcomes are more frequent in patients in whom biopsies show ballooning degeneration and Mallory hyaline or fibrosis.