Chow W C, Tai E S, Lian S C, Tan C K, Sng I, Ng H S
Department of Gastroenterology, Singapore General Hospital, Outram Road, Singapore 169608.
Singapore Med J. 2007 Aug;48(8):752-7.
To characterise the anthropometrical and metabolic parameters of a group of non-diabetic and non-obese patients who had histologically-proven nonalcoholic steatohepatitis (NASH).
During September 1997 to November 1999, consent for liver biopsies were sought from a consecutive series of patients, whose body mass index (BMI) were equal to or less than 30 kg per square metres, and who had persistently elevated serum alanine transaminase (more than 2.5 times upper limit of normal for more than six months), with no associated viral hepatitis, alcohol or drug-induced liver disease, hereditary liver disease and diabetes mellitus. Patients who were found to have steatohepatitis histologically were further studied. Their body weight, height, waist and hip circumferences were taken, and fasting serum lipid and glucose measured. Serum insulin was measured in six patients and insulin resistance (IR) was calculated by homeostasis model assessment. Oral glucose tolerance tests were done if fasting glucose levels were greater than 6 mmol/L. All liver biopsies were reviewed by a single histopathologist. Three age- and sex-matched controls were randomly selected for each patient.
11 of 12 patients who underwent liver biopsies were found to have NASH. All 11 were Chinese: eight males and three females. 73 percent of them had hepatic fibrosis. Overall, compared to controls, they had significantly higher body weight, BMI, IR and triglyceridaemia. The female patients also had a higher waist-hip ratio than controls. None had diabetes mellitus, and one had impaired glucose tolerance/fasting glycaemia. Nine out of 11 had BMI between 25 and 30 kg per square metres.
Significant histological changes of NASH with hepatic fibrosis were found in Singaporean Chinese non-diabetic patients with BMI of less than 30 kg per square metres.
对一组经组织学证实患有非酒精性脂肪性肝炎（NASH）的非糖尿病、非肥胖患者的人体测量和代谢参数进行特征描述。
在1997年9月至1999年11月期间，对一系列连续的患者进行肝活检，这些患者的体重指数（BMI）等于或小于每平方米30千克，血清丙氨酸转氨酶持续升高（超过正常上限的2.5倍达六个月以上），且无相关病毒性肝炎、酒精或药物性肝病、遗传性肝病及糖尿病。组织学检查发现有脂肪性肝炎的患者进一步接受研究。测量他们的体重、身高、腰围和臀围，并检测空腹血脂和血糖。对6名患者检测血清胰岛素，并通过稳态模型评估计算胰岛素抵抗（IR）。如果空腹血糖水平大于6毫摩尔/升，则进行口服葡萄糖耐量试验。所有肝活检标本均由一名组织病理学家复查。为每名患者随机选取三名年龄和性别匹配的对照。
12例接受肝活检的患者中有11例被发现患有NASH。所有11例均为中国人：8名男性和3名女性。其中73%有肝纤维化。总体而言，与对照组相比，他们的体重、BMI、IR和甘油三酯血症显著更高。女性患者的腰臀比也高于对照组。无人患有糖尿病，1人有糖耐量受损/空腹血糖受损。11例中有9例BMI在每平方米25至30千克之间。
在新加坡BMI小于每平方米30千克的非糖尿病华人患者中发现了伴有肝纤维化的NASH的显著组织学变化。
