非酒精性脂肪性肝病临床和病理学研究

A clinical and pathological study of nonalcoholic fatty liver disease

目的研究非酒精性脂肪性肝病(NAFLD)的临床与病理特征。方法分析41例NAFLD患者的肝组织脂肪变程度、炎症分级和纤维化分期,并研究其与体重指数(BMI)、血清生物化学和B超检查结果的关系。结果41 例NAFLD患者中,肝组织脂肪变分级:Ⅰ级21例(51．2％),Ⅱ级15例(36．6％),Ⅲ级5例(12．2％);肝组织炎症活动度分级:G0级2例(4．9％),G1级25例(61．0％),G2级10例(24．4％),G3级3例(7．3％),G4级1例(2．4％); 肝组织纤维化分期:S0期20例(48．8％),S1期14例(34．2％),S2期4例(9．8％),S3期2例(4．9％),S4期1例(2．4％)。肝脂肪变程度与肝炎症分级(r=-0．131 3,P=0．413)和肝纤维化分期(r=-0．179 2,P=0．262 3)均无显著的相关性。肝细胞脂肪变程度与BMI(r=0．669,P<0．01)和B超检测到的脂肪肝程度(r=0．366,P<0．01) 呈正相关,炎症活动度与丙氨酸氨基转移酶(ALT)(r=0．669,P=0．019)、天冬氨酸氨基转移酶(AST)(r= 0．438,P=0．005)和B超检测到的脂肪肝程度(r=0．562,P<0．001)呈正相关,而与血小板数呈负相关(r= -0．344,P=0．040);肝纤维化分期与ALT(r=0．449,P=0．003)、AST(r=0．477,P=0．002)、γ-谷氨酰转肽酶(r=0．373,P=0．025)和碱性磷酸酶(r=0．346,P=0．039)呈正相关,而与甘油三酯(r=-0．324, P=0．042)和血小板数(r=-0．375,P=0．024)呈负相关。结论肝脂肪变程度与炎症分级和肝纤维化分期均无显著的相关性,BMI、AST、ALT、血小板和B超检测到的脂肪肝程度等与肝组织病理学有关,肝活组织检查有助于明确诊断。

Objective To study the pathological and clinical features of nonalcoholic fatty liver disease （NAFLD）. Methods Grades and stages of liver lesions in 41 patients with NAFLD were analyzed. The relationships between pathohistological features of the livers, serum biochemical parameters, ultrasound examination and other clinical data of the patients were studied. Results Among the 41 patients with NAFLD （there were 21 with their liver fatty degeneration in grade 1, 15 in grade 2, and 5 in grade 3）. There were 2 of grade 0, grade 1 had 25, grade 2 had 10, grade 3 had 3, and grade 4 had 1. Stage 0 of fibrosis was 20, stage 1 was 14, stage 2 was 4, stage 3 was 2, and stage 4 was 1. Degree of fatty degeneration was not positively associated with the body mass index （BMI） of the patients and the ultrasound findings in their livers. Grading of the inflammation was positively related to the alanine aminotransferase （ALT） and aspartate aminotransferase （AST） levels in the blood and ultrasound findings in their livers, but negatively to the platelet counts. Staging of fibrosis of the livers was positively related to the blood ALT, AST, GGT, and ALP, and negatively to triglyceride levels.and platelet counts. Conclusions Degree of liver fatty degeneration was not associated with grades of inflammation and staging of fibrosis of the liver. BMI, ALT and AST level, platelet counts, and ultrasound grades of fatty liver were associated with the liver histopathological changes of NAFLD patients. Liver biopsy is the essential way to make a diagnosis of NAFLD.