A Clinical–Morphological Study on Cholestatic Presentation of Nonalcoholic Fatty Liver Disease
A Clinical–Morphological Study on Cholestatic Presentation of Nonalcoholic Fatty Liver Disease
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DOI：
10.1007/s10620-005-2719-1
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发表时间：
2005-06
影响因子：
3.1
通讯作者：
P. Sorrentino;Giovanni Tarantino;A. Perrella;P. Micheli;Oreste Perrella;P. Conca
中科院分区：
文献类型：
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作者：
P. Sorrentino;Giovanni Tarantino;A. Perrella;P. Micheli;Oreste Perrella;P. Conca
为了确定胆汁淤积症的临床、生化和组织学特征之间的相关性，我们分析了我们的非酒精性脂肪性肝病(NAFLD)数据库中记录的所有患者的相关数据。我们选择了20例转氨酶异常的非酒精性脂肪肝患者，碱性磷酸酶≥500U/L和γ-谷氨酰转肽酶≥250U/L，并与一组性别、年龄、体重指数匹配的非酒精性脂肪肝患者和一组性别、体重指数和组织学非酒精性脂肪肝分级/分期匹配的患者进行了组织学特征的比较。在组织学上，病例和对照符合NASH的标准。本组患者胆汁淤积与胆管上皮损伤相关，表现为胆管炎、肿胀、可变性胆管丢失和胆汁淤积。与年龄、性别和体重指数相似的非酒精性脂肪肝患者相比，胆汁淤积组的肝组织学损害完全严重。当我们分析根据相同的分期和分级严重程度在组织学上确定的患者组时，我们没有发现任何与病例相比有显著胆汁损伤的证据，尽管对照组的年龄要大得多。伴有生化胆汁淤积的NAFLD患者有胆汁损害的组织学图像；他们的组织学损害比年龄、性别和体重指数匹配的患者更严重。
To determine the association among the clinical, biochemical, and histological features of cholestasis, we analyzed all the relevant data of the patients recorded in our non-alcoholic fatty liver disease (NAFLD) database. We selected 20 NAFLD patients with abnormal transaminase levels, with both alkaline phosphatase ≥500 U/L and γ-glutamyl transpeptidase ≥250 U/L. Their histological features were compared with those of a group of patients with NAFLD matched for sex, age, and body mass index and of a group of patients matched for sex, body mass index and histological NAFLD grading/staging. Cases and controls satisfied, on histology, the criteria for NASH. The presence of cholestasis in our patients was correlated with injury of the bile duct epithelium, characterized by cholangitis, swelling, variable bile duct loss, and bile stasis. Compared to NAFLD patients of similar age, sex, and body mass index, the cholestatic group had total and severe histological liver impairment. When we analyzed the group of patients histologically identified on the basis of identical stage and grade severity, we could not find any evidence of significant bile damage, compared to cases, despite the control group’s significantly older age. NAFLD patients with biochemical cholestasis have a histological picture of bile damage; they have more advanced histological impairment than patients matched for age, sex and body mass index.