2nd Department of Internal Medicine, Athens University Medical School, Hippokration General Hospital of Athens, Athens, Greece.
J Hepatol. 2009 Nov;51(5):931-8. doi: 10.1016/j.jhep.2009.06.023. Epub 2009 Aug 3.
BACKGROUND/AIMS: The pathogenetic mechanisms of development of non-alcoholic steatohepatitis (NASH) and fibrosis are not clear, although thrombosis of small intrahepatic veins has been suggested to trigger liver tissue remodelling and thrombotic risk factors have been associated with more advanced fibrosis in chronic viral hepatitis (CVH). We evaluated the prevalence of thrombotic risk factors (RFs) in non-alcoholic fatty liver disease (NAFLD) and their possible association with fatty liver or NASH.
We included 60 patients with histologically documented NAFLD and a historical cohort of 90 patients with chronic hepatitis B (n=39) or C (n=51). Thrombophilic factors were evaluated on the day of the liver biopsy.
One or more thrombotic RFs were detected in 37% of NAFLD patients, and >or= 2 RFs were detected in 12% of NAFLD patients, being less frequently present than in CVH patients (37% and 68%, respectively; P <or= 0.001). Among NAFLD cases, one or more thrombotic RFs were significantly more frequently present in NASH than simple fatty liver (56% vs. 8%; odds ratio [OR]: 13.8, 2.8-67.4, P<0.001). In multivariate analysis, NASH was independently associated with moderate to severe steatosis (adjusted OR: 24.3; P=0.001) and the presence of one or more thrombotic RFs (adjusted OR: 38.7; P=0.002). Fibrosis stage was worse in NASH patients with than without thrombotic RFs (2.5+/-1.1 vs. 1.3+/-1.1; P=0.002).
Thrombotic RFs are frequently present in patients with NAFLD and are associated with NASH and more advanced fibrosis. Such an association may have significant clinical implications, even though it is not clear yet whether it represents a primary or secondary phenomenon.
背景/目的：非酒精性脂肪性肝炎（NASH）和纤维化的发病机制尚不清楚，尽管已经提出小的肝内静脉血栓形成可能触发肝组织重塑，并且血栓形成危险因素与慢性病毒性肝炎（CVH）中的更严重纤维化有关。我们评估了非酒精性脂肪性肝病（NAFLD）中血栓形成危险因素（RFs）的患病率及其与脂肪肝或 NASH 的可能关联。
我们纳入了 60 名经组织学证实的 NAFLD 患者和一个历史队列的 90 名慢性乙型肝炎（n=39）或丙型肝炎（n=51）患者。在肝活检当天评估血栓形成因子。
37%的 NAFLD 患者检测到一种或多种血栓形成 RFs，12%的 NAFLD 患者检测到>或=2 种 RFs，比 CVH 患者（分别为 37%和 68%；P<0.001）少。在 NAFLD 病例中，NASH 比单纯性脂肪肝更频繁地存在一种或多种血栓形成 RFs（56% vs. 8%；优势比[OR]：13.8，2.8-67.4，P<0.001）。在多变量分析中，NASH 与中重度脂肪变性（调整后的 OR：24.3；P=0.001）和一种或多种血栓形成 RFs 的存在（调整后的 OR：38.7；P=0.002）独立相关。有血栓形成 RFs 的 NASH 患者的纤维化分期比没有血栓形成 RFs 的患者更差（2.5+/-1.1 vs. 1.3+/-1.1；P=0.002）。
血栓形成 RFs 在 NAFLD 患者中频繁出现，与 NASH 和更严重的纤维化相关。这种关联可能具有重要的临床意义，尽管尚不清楚它是原发性还是继发性现象。
