非酒精性脂肪性肝炎的临床病理研究

CLINICAL AND PATHOLOGICAL CHARACTERISTICS OF NONALCOHOLIC STEATOHEPATITIS

探讨非酒精性脂肪性肝炎 (NASH)的临床和病理学特征。对 4 0例NASH患者的临床资料和穿刺肝组织进行临床和病理学分析 ,并与酒精性脂肪性肝炎 (ASH)和丙型肝炎 (HCV)患者各 2 0例作对照。 90 %NASH患者肥胖 ,血浆总蛋白平均水平高于ASH。NASH的组织学改变类似ASH ,但有些组织学改变如脂肪变性、汇管区的炎症程度 ,Mallory小体和空泡状核的出现频率等两者间差异有显著性意义。NASH有其相对的病理特征 :大小泡混合型脂肪变性 ,以大泡为主 ;肝细胞气球样变性 ,小叶中央区较常见 ,气球样变性的细胞胞浆内常有嗜碱性的细颗粒 ;肝小叶内炎症 ,不典型的Mallory小体 ,汇管区周围易见空泡状核细胞。多数NASH患者的肝小叶中央区有不同程度的窦周纤维化。NASH有一些相对的临床和病理学特征 ,临床、病理及实验室检查相结合能对NASH作出肯定的诊断 ,其中病理活检仍然是诊断NASH的“金标准”。

To explore the clinical and pathological characteristics of non alcoholic steatohepatitis(NASH), clinical, laboratory records and liver biopsy specimens of 40 cases of NASH, 20 cases of alcoholic steatohepatitis(ASH) and 20 cases of HCV were compared. The frequency of obesity was significtantly greater in NASH than in ASH patients, while the mean level of total serum protein was higher in patients with NASH than that in those with ASH. The histopathologic lesions in NASH were similar but not identical to those of ASH. Significant differences were found in the grade of steatosis, portal inflammation, Mallory bodies and nuclear vacuolation. The lesions most commonly accepted for NASH include steatosis(macro>micro), hepatocyte ballooning degeneration, mild diffuse lobular inflammation and perisinusoidal collagen deposition. Zone 3 accentuation could be detected. Mallory hyaline, vacuolated nuclei in periportal hepatocytes were common. NASH has some clinical and pathological characteristics. The authors hold that combinative consideration of clinics, pathology and laboratory can ensure the diagnosis of NASH, and liver biopsy interpretation continues to be the 'gold standard ' for diagnosis.