Hübscher S G
Department of Pathology, University of Birmingham, Birmingham, UK.
Histopathology. 2006 Nov;49(5):450-65. doi: 10.1111/j.1365-2559.2006.02416.x.
Non-alcoholic fatty liver disease (NAFLD) is an important complication of the metabolic syndrome, which is becoming an increasingly common cause of chronic liver disease. Histological changes typically mainly affect perivenular regions of the liver parenchyma and include an overlapping spectrum of steatosis, steatohepatitis and persinusoidal or pericellular fibrosis, in some cases leading to cirrhosis. Once cirrhosis has developed, typical hepatocellular changes are often no longer conspicuous, leading to such cases being mistakenly diagnosed as 'cryptogenic'. Portal inflammation, ductular reaction and periportal fibrosis can also be seen as part of the morphological spectrum of NAFLD, particularly in the paediatric population. Hepatocellular carcinoma has also been described as a complication of NAFLD-associated cirrhosis. NAFLD is also an important cofactor in other chronic liver diseases, especially hepatitis C. Histological assessments have an important role to play in the diagnosis and management of NAFLD. These include making the potentially important distinction between simple steatosis and steatohepatitis and providing pointers to the aetiology, including cases where a dual pathology exists. A number of systems have been devised for grading and staging the severity of fatty liver disease. These require further evaluation, but have a potentially important role to play in determining prognosis and monitoring therapeutic responses.
非酒精性脂肪性肝病（NAFLD）是代谢综合征的一种重要并发症，正日益成为慢性肝病的常见病因。组织学改变通常主要影响肝实质的小叶中央静脉周围区域，包括脂肪变性、脂肪性肝炎以及窦周或细胞周围纤维化等一系列重叠的病变，在某些情况下可导致肝硬化。一旦发展为肝硬化，典型的肝细胞改变往往不再明显，导致此类病例被误诊为“隐源性”。门管区炎症、小胆管反应和门管区周围纤维化也可视为NAFLD形态学谱的一部分，尤其是在儿童人群中。肝细胞癌也被描述为NAFLD相关肝硬化的一种并发症。NAFLD也是其他慢性肝病（尤其是丙型肝炎）的重要辅助因素。组织学评估在NAFLD的诊断和管理中发挥着重要作用。这些评估包括对单纯脂肪变性和脂肪性肝炎进行潜在的重要区分，并为病因提供线索，包括存在双重病理的情况。已经设计了一些系统用于对脂肪性肝病的严重程度进行分级和分期。这些系统需要进一步评估，但在确定预后和监测治疗反应方面可能发挥重要作用。
