Evidence of NAFLD progression from steatosis to fibrosing-steatohepatitis using paired biopsies: Implications for prognosis and clinical management
Evidence of NAFLD progression from steatosis to fibrosing-steatohepatitis using paired biopsies: Implications for prognosis and clinical management
复制标题
DOI：
10.1016/j.jhep.2014.11.034
复制
发表时间：
2015-05-01
影响因子：
25.7
通讯作者：
Anstee, Quentin M.
中科院分区：
文献类型：
--
作者：
McPherson, Stuart;Hardy, Tim;Anstee, Quentin M.
背景和目的：非酒精性脂肪性肝病(NAFLD)的自然病史仍不确定。NAFLD包括非酒精性脂肪肝(NAFL；无肝细胞损伤的脂肪变性)和脂肪性肝炎(NASH；脂肪变性伴肝细胞气球变性+/-纤维化)。我们的目的是通过一系列的活检数据来评估NAFLD的组织学严重程度，并确定预测疾病进展的因素。结果：108例患者接受了连续肝活检，中位间隔时间为6.6年，范围为1.3~22.6年。NASH 81例(75%)，NAFL 27例。总体而言，45名患者(42%)有纤维化进展，43名(40%)纤维化无变化，20名(18%)纤维化消退。重要的是，在指数活检中，NAFL和NASH患者之间显示纤维化进展的比例没有显著差异(37%比43%，p=0.65)。在基线的NAFL患者中，有44%的患者进展为NASH。10例纤维化进展的NAFL患者中，3例进展为1期，5例进展为2期，2例进展为3期，随访活检均为NASH。值得关注的是，在27名基线NAFL患者中，有6名(22%)在随访活检时达到了3期纤维化。在非酒精性脂肪肝患者中，80%的肝纤维化进展者在随访肝活检时患有糖尿病(p=0.005)，而非进展者中这一比例为25%(p=0.005)。结论：与目前的教条相反，本研究提示脂肪变性可进展为NASH和临床显著的纤维化。(C)2014年欧洲肝脏研究协会。爱思唯尔出版，版权所有。
Background and Aims: There remains uncertainty about the natural history of non-alcoholic fatty liver disease (NAFLD). The spectrum of NAFLD includes non-alcoholic fatty liver (NAFL; steatosis without hepatocellular injury) and steatohepatitis (NASH; steatosis with hepatocyte ballooning degeneration +/- fibrosis). Our aim was to assess the histological severity of NAFLD in a cohort with serial biopsy data, and determine factors predicting progression.Methods: Patients with two liver biopsies more than a year apart were identified. Clinical and laboratory data were collected from the time of liver biopsy.Results: 108 patients had serial biopsies (median interval 6.6 years, range 1.3-22.6). 81 (75%) patients had NASH and 27 had NAFL. Overall, 45 (42%) patients had fibrosis progression, 43 (40%) had no change in fibrosis, while 20 (18%) had fibrosis regression. Importantly, no significant difference in the proportion exhibiting fibrosis progression was found between those with NAFL or NASH at index biopsy (37% vs. 43%, p = 0.65). Progression to NASH was seen in 44% of patients with baseline NAFL. Of 10 patients with NAFL who had fibrosis progression, 3 progressed by 1 stage, 5 by 2 stages and 2 by 3 stages; all had NASH on follow-up biopsy. Of concern, 6 of 27 (22%) patients with baseline NAFL, reached stage 3 fibrosis at follow-up biopsy. Among the patients with NAFL, 80% of those having fibrosis progression were diabetic at the follow-up liver biopsy compared with 25% of non-progressors (p = 0.005).Conclusions: Contrary to current dogma, this study suggests that steatosis can progress to NASH and clinically significant fibrosis. (C) 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.