Influence of liver biopsy heterogeneity and diagnosis of nonalcoholic steatohepatitis in subjects undergoing gastric bypass
Influence of liver biopsy heterogeneity and diagnosis of nonalcoholic steatohepatitis in subjects undergoing gastric bypass
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DOI：
10.1007/s11695-007-9041-2
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发表时间：
2007-02-01
期刊：
影响因子：
2.9
通讯作者：
Abrams, Gary A.
中科院分区：
文献类型：
--
作者：
Arun, Janani;Jhala, Niraj;Abrams, Gary A.
背景：非酒精性脂肪肝病（NAFLD）是一种慢性疾病，可进展为肝硬化和肝细胞癌。 NAFLD 最进展的形式是非酒精性脂肪性肝炎 (NASH)。目前，诊断 NASH 的唯一方法是肝活检；然而。采样误差可能会限制诊断的准确性。我们调查了接受胃绕道手术的个体中配对肝活检的不一致情况。方法：从 31 名受试者的左叶获得了两份肝活检，复合尺寸 >= 5 毫米且 >= 8 个汇管 (PT)。第 1 组包括长度至少 15 毫米且具有 A PT 的标本，而第二次活检长度至少为 10 毫米且≥ 4 个 PT（第 2 组）。结果：第 1 组的平均标本尺寸（PT 数量）为 20.4 +/- 4.2 毫米（11.7 +/- 5.5 PT），第 2 组为 16.1 +/- 5.3 毫米（8.2 +/- 5.3 毫米） 4.1 PT）。第 1 组的 NASH 患病率为 26%，第 2 组为 32%。门脉纤维化的采样不一致最大（26%），其次是第 3 区纤维化（13%）和气球样变（3%）。第 1 组肝活检对 NASH 和门静脉纤维化的阴性预测值分别仅为 83% 和 67%。 结论：结果表明，在接受 NAFLD 肝活检筛查的 2 级和 3 级肥胖个体中存在显着的采样变异性。程度和组织病理学不一致取决于损伤的区域位置和类型。尽管如此，没有 3 区细胞膨胀或纤维化的 25 毫米活检标本似乎足以排除 NASH 的诊断。
Background: Nonalcoholic fatty liver disease (NAFLD) is a chronic condition that can progress to cirrhosis and hepatocellular cancer. The most progressive form of NAFLD is nonalcoholic steatohepatitis (NASH). Currently, the only method to diagnose NASH is with a liver biopsy; however. sampling error may limit diagnostic accuracy. We investigated the discordance of paired liver biopsies in individuals undergoing gastric bypass.Methods: Two liver biopsies, composite size of >= 5 mm and >= 8 portal tracts (PTs), were obtained from the left lobe in 31 subjects. Group 1 included specimens at least 15 mm in length with A PTs compared to a second biopsy of at least 10 mm and >= 4 PTs (Group 2).Results: The mean specimen size (number of PTs) for group 1 was 20.4 +/- 4.2 mm (11.7 +/- 5.5 PTs) and group 2 was 16.1 +/- 5.3 mm (8.2 +/- 4.1 PTs). Prevalence of NASH was 26% in Group 1 and 32% in Group 2. Sampling discordance was greatest for portal fibrosis (26%), followed by zone 3 fibrosis (13%) and ballooning degeneration (3%). The negative predictive values from Group 1 liver biopsies for NASH and portal fibrosis were only 83% and 67%, respectively.Conclusions: The results demonstrate that significant sampling variability exists in class 2 and 3 obese individuals undergoing screening liver biopsies for NAFLD. The degree and histopathological discordance is dependent upon zonal location and types of injury. Nevertheless, a 25-mm biopsy specimen without zone 3 cellular ballooning or fibrosis appears adequate to exclude the diagnosis of NASH.