Duseja Ajay, Das Ashim, Das Reena, Dhiman R K, Chawla Y, Bhansali A, Kalra Naveen
Department of Hepatology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 060012, India.
Dig Dis Sci. 2007 Sep;52(9):2368-74. doi: 10.1007/s10620-006-9136-y. Epub 2007 Apr 10.
There are limited data on nonalcoholic fatty liver disease (NAFLD) from India. The clinicopathological profile of Indian patients with NAFLD may be different from that of Western patients. One hundred NAFLD patients with increased liver enzymes were prospectively evaluated for clinical presentation, associated diseases, overweight/obesity, central obesity (n=54), presence of diabetes mellitus, lipid abnormalities, insulin resistance (n=39), metabolic syndrome (n=54), serum iron, serum ferritin, and transferrin saturation (n=60), and HFE gene mutations (n=30). Risk factors for the grade and stage of the disease on histology were studied in 38 biopsy-proven patients. Patients were treated with lifestyle modifications and ursodeoxycholic acid (UDCA). Seventeen nonresponder patients were treated with metformin. The majority of patients were males (n=70). Twenty percent of patients were overweight, 68% had obesity, and 78% had central obesity. Abnormal cholesterol, HDL, and triglycerides were present in 36%, 66%, and 53% of patients, respectively. Twelve percent of patients had diabetes mellitus and 16% patients had various associated diseases. All 22 (100%) patients studied by ITT and all but 1 (98%) studied by HOMA-IR were found to have reduced insulin sensitivity and 50% were found to have metabolic syndrome by the modified ATP III criteria. Two (3%) patients were found to have high serum iron, 4 (7%) patients had high ferritin, 5 (8%) patients had increased transferrin saturation, and 4 (13%) patients were found to be heterozygotes for H63D HFE gene mutation. Twenty patients of 38 (53%) had histological evidence of NASH (class 3=6, class 4=14). The other 18 (47%) qualified for class I (n=1) or class II (n=17) NAFLD. Four (10.5%) patients had bridging fibrosis and none had evidence of cirrhosis liver. Seventy-four (74%) patients achieved a biochemical response to lifestyle modification and UDCA. All 17 patients treated with metformin had a reduction in ALT level and 10 (59%) of them had normalization of their enzymes. We conclude that the clinicopathological profile of NAFLD in Indian patients is different from that in the West.
关于印度非酒精性脂肪性肝病（NAFLD）的数据有限。印度NAFLD患者的临床病理特征可能与西方患者不同。对100例肝酶升高的NAFLD患者进行了前瞻性评估，内容包括临床表现、相关疾病、超重/肥胖、中心性肥胖（n = 54）、糖尿病的存在、脂质异常、胰岛素抵抗（n = 39）、代谢综合征（n = 54）、血清铁、血清铁蛋白和转铁蛋白饱和度（n = 60）以及HFE基因突变（n = 30）。对38例经活检证实的患者研究了疾病组织学分级和分期的危险因素。患者接受生活方式调整和熊去氧胆酸（UDCA）治疗。17例无反应患者接受二甲双胍治疗。大多数患者为男性（n = 70）。20%的患者超重，68%患有肥胖症，78%有中心性肥胖。分别有36%、66%和53%的患者存在胆固醇、高密度脂蛋白和甘油三酯异常。12%的患者患有糖尿病，16%的患者有各种相关疾病。通过ITT研究的所有22例（100%）患者以及通过HOMA-IR研究的除1例（98%）之外的所有患者均发现胰岛素敏感性降低，根据改良的ATP III标准，50%的患者患有代谢综合征。2例（3%）患者血清铁升高，4例（7%）患者铁蛋白升高，5例（8%）患者转铁蛋白饱和度升高，4例（13%）患者被发现为H63D HFE基因突变杂合子。38例患者中的20例（53%）有非酒精性脂肪性肝炎（NASH）的组织学证据（3级 = 6例，4级 = 14例）。其他18例（47%）符合I级（n = 1）或II级（n = 17）NAFLD。4例（10.5%）患者有桥接纤维化，无肝硬化证据。74例（74%）患者对生活方式调整和UDCA有生化反应。所有17例接受二甲双胍治疗的患者ALT水平均降低，其中10例（59%）酶水平恢复正常。我们得出结论，印度患者NAFLD的临床病理特征与西方不同。
