非酒精性脂肪性肝炎和年龄及性别对组织病理学发现的影响。
Non-alcoholic steatohepatitis and influence of age and gender on histopathologic findings.
机构信息
Department of Gastroenterology and Hepatology, Tehran University of Medical Sciences, Tehran 19686-13113, Iran.
出版信息
World J Gastroenterol. 2010 Sep 7;16(33):4169-75. doi: 10.3748/wjg.v16.i33.4169.
AIM
To characterize the histopathologic specifications of non-alcoholic steatohepatitis (NASH) according to age and gender.
METHODS
An analytical cross-sectional study was conducted in two private gastroenterology clinics on biopsy proven patients suffering from NASH. Biopsy histopathologic findings as well as demographic and laboratory data of the patients at the time of biopsy were gathered retrospectively from clinical records. The grading and staging of histopathologic findings were performed according to the Brunt method after reevaluation of the slides by a pathologist. Patients were divided into two groups according to age (below and above 55 years). Mean quantitative grade of all pathologic findings were also calculated according to Brunt scoring values.
RESULTS
A total number of 77 NASH patients, consisting of 58 males (75.3%) and 19 (24.7%) females with a mean age of 41.99 +/- 11.80 years (range, 18-70 years), were enrolled. The mean age (48.72 +/- 13.99 years vs 39.74 +/- 10.16 years, P = 0.004) and aspartate aminotransferase level (75.11 +/- 29.68 U/L vs 52.78 +/- 25.00 U/L, P = 0.002) was significantly higher in female patients. Mean quantitative grade of hepatosteatosis was significantly higher in females (2.00 +/- 0.82 vs 1.59 +/- 0.68, P = 0.031) compared to males. Fifty four percent (34/65) of young patients had mild hepatosteatosis (Grade I) while only one patient (11.2%) in the older group had grade I hepatosteatosis. Patients aged > or = 55 had significantly more severe hepatosteatosis (Grade III) (44.4% vs 9.5%, P = 0.007) and the mean quantitative grade of hepatosteatosis was significantly higher among them (2.33 +/- 0.71 vs 1.56 +/- 0.67, P = 0.002). Multivariate analysis after omitting the confounding role of age revealed a higher grade of hepatosteatosis in female patients (P = 0.010).
CONCLUSION
These findings point toward the possible influence of age in the severity of steatohepatitis, portal and lobar inflammation in patients suffering from NASH while gender independently might contribute to the level of steatohepatitis.
目的
根据年龄和性别描述非酒精性脂肪性肝炎（NASH）的组织病理学特征。
方法
在两家私人胃肠病诊所进行了一项分析性横断面研究，对活检证实为 NASH 的患者进行了研究。从临床记录中回顾性收集患者活检时的组织病理学发现以及人口统计学和实验室数据。根据 Brunt 方法对切片进行重新评估后，对组织病理学发现进行分级和分期。根据年龄（< 55 岁和> 55 岁）将患者分为两组。还根据 Brunt 评分值计算了所有病理发现的平均定量分级。
结果
共纳入 77 名 NASH 患者，其中男性 58 名（75.3%），女性 19 名（24.7%），平均年龄为 41.99 +/- 11.80 岁（范围，18-70 岁）。女性患者的平均年龄（48.72 +/- 13.99 岁 vs 39.74 +/- 10.16 岁，P = 0.004）和天冬氨酸氨基转移酶水平（75.11 +/- 29.68 U/L vs 52.78 +/- 25.00 U/L，P = 0.002）明显更高。女性患者的肝脂肪变性定量分级明显更高（2.00 +/- 0.82 与 1.59 +/- 0.68，P = 0.031）。65 名年轻患者中有 54%（34/65）为轻度肝脂肪变性（I 级），而老年组中只有 1 名患者（11.2%）为 I 级肝脂肪变性。年龄> = 55 岁的患者肝脂肪变性明显更严重（III 级）（44.4% vs 9.5%，P = 0.007），且肝脂肪变性定量分级明显更高（2.33 +/- 0.71 与 1.56 +/- 0.67，P = 0.002）。排除年龄混杂因素后的多变量分析显示，女性患者肝脂肪变性程度更高（P = 0.010）。
结论
这些发现表明，年龄可能影响 NASH 患者的肝炎、门脉和肝小叶炎症的严重程度，而性别可能独立影响肝炎的严重程度。
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