Kojima Hideyuki, Sakurai Shinya, Uemura Masahito, Takekawa Takashi, Morimoto Hiroyo, Tamagawa Yasuhiro, Fukui Hiroshi
Third Department of Internal Medicine, Nara Medical University, Japan.
Alcohol Clin Exp Res. 2005 Dec;29(12 Suppl):259S-63S. doi: 10.1097/01.alc.0000191776.37626.30.
Non-alcoholic steatohepatitis (NASH) and alcoholic liver disease (ALD) are extremely similar in the pathologic findings and pathogenesis. This study aimed to elucidate the difference and similarity between these diseases.
Twenty-six patients with NASH and 26 with ALD including 11 with alcoholic hepatitis underwent clinico-pathologic analysis. The visceral fat area and liver/spleen ratio, an index of the hepatic fat content, were evaluated with computed tomography. The hepatic iron deposit and oxidative stress induced-lipid peroxidation were estimated by Prussian blue staining and 3-nitrotyrosine staining, respectively.
The most prominent difference between NASH and ALD was the nutritional status, although elevation of AST/ALT ratio and gamma-GT is relatively characteristic of ALD. NASH was more frequently associated with diabetes mellitus as compared with ALD. The BMI and serum levels of total cholesterol and cholinesterase were higher in NASH than in ALD. Although the degree and distribution of fibrosis and necro-inflammatory reaction were similar in NASH and ALD, steatosis was more severe in NASH than in ALD. The liver/spleen ratio was lower and the visceral fat area was larger in NASH than in ALD, regardless of the coincidence of alcoholic hepatitis. Interestingly, the visceral fat area positively correlated with ALT and HOMA-IR in NASH, whereas these correlations were not observed in ALD. The hepatic iron deposit was less in NASH than in ALD, whereas lipid peroxidation in NASH was similar to that in ALD with alcoholic hepatitis and more advanced as compared with that in ALD without alcoholic hepatitis.
NASH was characterized with over-nutrition and visceral fat type obesity as compared with ALD. The visceral fat accumulation was associated with hepatic inflammation and insulin resistance in NASH, but not in ALD. The difference in the nutritional status between NASH and ALD is not only reflected in the clinical features but also may closely associate with the mechanisms of hepatocellular damage in these diseases.
非酒精性脂肪性肝炎（NASH）和酒精性肝病（ALD）在病理表现和发病机制上极为相似。本研究旨在阐明这两种疾病之间的差异和相似之处。
对26例NASH患者和26例ALD患者（包括11例酒精性肝炎患者）进行临床病理分析。通过计算机断层扫描评估内脏脂肪面积和肝脏/脾脏比值（肝脂肪含量指标）。分别采用普鲁士蓝染色和3-硝基酪氨酸染色评估肝脏铁沉积和氧化应激诱导的脂质过氧化。
NASH和ALD最显著的差异在于营养状况，尽管AST/ALT比值升高和γ-GT升高相对更具ALD的特征。与ALD相比，NASH更常与糖尿病相关。NASH患者的BMI以及总胆固醇和胆碱酯酶的血清水平高于ALD患者。尽管NASH和ALD的纤维化程度及分布以及坏死性炎症反应相似，但NASH的脂肪变性比ALD更严重。无论是否合并酒精性肝炎，NASH的肝脏/脾脏比值均低于ALD，且内脏脂肪面积大于ALD。有趣的是，NASH患者的内脏脂肪面积与ALT和HOMA-IR呈正相关，而在ALD患者中未观察到这些相关性。NASH的肝脏铁沉积少于ALD，而NASH的脂质过氧化与酒精性肝炎的ALD相似，且比无酒精性肝炎的ALD更严重。
与ALD相比，NASH的特征是营养过剩和内脏脂肪型肥胖。NASH中内脏脂肪堆积与肝脏炎症和胰岛素抵抗相关，而ALD中则不然。NASH和ALD在营养状况上的差异不仅体现在临床特征上，还可能与这些疾病中肝细胞损伤的机制密切相关。
