非酒精性脂肪性肝病的临床和组织学特征

[Clinical and histological features of non-alcoholic fatty liver disease].

作者信息

Shi Jun-ping, Xun Yun-hao, Hu Chen-bo, Zhang Li, Liu Hong, Lou Guo-qiang, Fan Jian-gao

机构信息

Hangzhou Sixth Hospital, Zhejiang University of Traditional Chinese Medicine, Hangzhou 310014, China.

出版信息

Zhonghua Gan Zang Bing Za Zhi. 2009 Nov;17(11):812-6.

PMID:19958638

Abstract

OBJECTIVE

To investigate the clinical and histological features in Chinese patients with non-alcoholic fatty liver disease (NAFLD).

METHODS

108 patients with biopsy-proven NAFLD were enrolled in this study. Clinical, demographic, and biochemical data were compared between NAFLD patients with abnormal ALT and those with normal ALT.

RESULTS

Simple fatty liver, nonalcoholic steatohepatitis(NASH) and cirrhosis were diagnosed in 49 (45.4%), 57(52.7%) and 2 (1.9%) patients, respectively. ALT and AST levels of NASH group were higher than those of simple fatty liver group (t = 2.55, 3.13; P = 0.01, 0.00). Fifty of the 77 patients (64.9%) with abnormal ALT levels were diagnosed as non-alcoholic steatohepatitis (NASH), and twenty-six were diagnosed as simple fatty liver, according to liver histology. Among the 31 patients with normal ALT levels, nine (29%) had NASH and twenty-two had simple fatty liver (P = 0.00). The patients with normal ALT had lower necroinflammatory grade than patients with abnormal ALT (x2 = 10.30, P = 0.01), but they had similar degree of steatosis and fibrosis (x2 = 5.52, 6.12; P = 0.12, 0.01). AST, g-glutamyltransferase, total cholesterol, apolipoprotein A1, apolipoprotein B and systolic blood pressure of patients with normal ALT were all lower than those of patients with abnormal ALT (t = 5.91, 2.00, 2.30, 2.10, 3.14, 2.43; P = 0.00, 0.05, 0.02, 0.04, 0.00, 0.02), while spleen thickness and AST/ALT ratio in patients with normal ALT were higher than those with abnormal ALT significantly (t = 3.70, 2.95; P = 0.00, 0.01). Multivariate analysis revealed that ALT (OR = 2.78, 95% CI 1.06-7.3, P = 0.04) was the only independent predictor of NASH, and ALT had low accuracy in predicting NASH, the area under the receiver operating characteristics curves of ALT to predict NASH was 0.69 (95% CI 0.59-0.8, P = 0.00).

CONCLUSION

NAFLD patients have higher ALT level, and elevated serum level of ALT is independent predictor of the degree of inflammation, but not of steatosis and fibrosis.

摘要

目的

探讨中国非酒精性脂肪性肝病（NAFLD）患者的临床和组织学特征。

方法

本研究纳入108例经活检证实为NAFLD的患者。比较了谷丙转氨酶（ALT）异常和正常的NAFLD患者的临床、人口统计学和生化数据。

结果

分别有49例（45.4%）、57例（52.7%）和2例（1.9%）患者被诊断为单纯性脂肪肝、非酒精性脂肪性肝炎（NASH）和肝硬化。NASH组的ALT和谷草转氨酶（AST）水平高于单纯性脂肪肝组（t = 2.55，3.13；P = 0.01，0.00）。根据肝脏组织学检查，77例ALT异常的患者中有50例（64.9%）被诊断为非酒精性脂肪性肝炎（NASH），26例被诊断为单纯性脂肪肝。在31例ALT水平正常的患者中，9例（29%）患有NASH，22例患有单纯性脂肪肝（P = 0.00）。ALT正常的患者坏死性炎症分级低于ALT异常的患者（x2 = 10.30，P = 0.01），但他们的脂肪变性和纤维化程度相似（x2 = 5.52，6.12；P = 0.12，0.01）。ALT正常患者的AST、γ-谷氨酰转移酶、总胆固醇、载脂蛋白A1、载脂蛋白B和收缩压均低于ALT异常患者（t = 5.91，2.00，2.30，2.10，3.14，2.43；P = 0.00，0.05，0.02，0.04，0.00，0.02），而ALT正常患者的脾脏厚度和AST/ALT比值显著高于ALT异常患者（t = 3.70，2.95；P = 0.00，0.01）。多因素分析显示，ALT（OR = 2.78，95%可信区间1.06 - 7.3，P = 0.04）是NASH的唯一独立预测因素，且ALT预测NASH的准确性较低，ALT预测NASH的受试者工作特征曲线下面积为0.69（95%可信区间0.59 - 0.8，P = 0.00）。