Department of Pathology, Cleveland Clinic, USA.
J Pediatr Gastroenterol Nutr. 2011 Feb;52(2):190-7. doi: 10.1097/MPG.0b013e3181fb47d3.
The relations between hepatic steatosis and histological features of hepatocyte injury in children with nonalcoholic fatty liver disease have yet to be examined. The aims of the present study were to establish associations between steatosis amount, type, and distribution in a well-characterized group of children with biopsy-proven nonalcoholic fatty liver disease (NAFLD).
One hundred eight children with NAFLD seen in 5 centers were studied. Clinical and laboratory data were collected. Hematoxylin-eosin and Masson trichrome stains were evaluated by 2 expert liver pathologists. Steatosis grade (0-3), type (macrovesicular, microvesicular, or mixed), and zone (1, 3, azonal, or panacinar) were determined. The NAFLD activity score and fibrosis stage were determined.
Median patient age was 12 years and median body mass index was 31 kg/m. Fibrosis was present in 87%. The median NAFLD activity score was 4. Mild, moderate, and severe steatosis were present in 42%, 34%, and 24% of biopsies, respectively. Macrovesicular steatosis was present in 81% and mixed steatosis was present in 19%. Panacinar distribution of steatosis was most frequent (40%), followed by azonal (27%). Steatosis grade positively correlated with portal inflammation (P = 0.018). Azonal distribution positively correlated with presence of hepatocyte ballooning (P = 0.03). Biopsies with mixed steatosis were approximately 20 times more likely to have megamitochondria than those with macrovesicular steatosis alone (95% confidence interval 2.3-204.9). There was no relation between steatosis amount, type, or distribution to fibrosis stage.
Specific histological patterns of steatosis in children are associated with histological markers of steatohepatitis. Ballooning and portal inflammation correlated well with features of steatosis.
非酒精性脂肪性肝病（NAFLD）患儿肝脂肪变与肝细胞损伤的组织学特征之间的关系尚未得到研究。本研究的目的是在一组经活检证实的非酒精性脂肪性肝病（NAFLD）患儿中，建立肝脂肪变程度、类型和分布与脂肪变之间的相关性。
本研究共纳入了 5 家中心的 108 例 NAFLD 患儿。收集了临床和实验室数据。两位肝脏病理专家评估了苏木精-伊红和 Masson 三色染色的结果。确定了脂肪变程度（0-3 级）、类型（大泡性、小泡性或混合性）和分布区（1 区、3 区、无区或全腺泡区）。还确定了 NAFLD 活动评分和纤维化分期。
患儿的中位年龄为 12 岁，中位体重指数为 31kg/m。87%的患儿存在纤维化。NAFLD 活动评分的中位数为 4。42%、34%和 24%的活检存在轻度、中度和重度脂肪变。81%的患儿存在大泡性脂肪变，19%的患儿存在混合性脂肪变。脂肪变的全腺泡分布最常见（40%），其次是无区分布（27%）。脂肪变程度与门管区炎症呈正相关（P=0.018）。无区分布与肝细胞气球样变呈正相关（P=0.03）。与单纯大泡性脂肪变相比，存在混合性脂肪变的活检中巨线粒体的可能性约为 20 倍（95%置信区间 2.3-204.9）。脂肪变程度、类型或分布与纤维化分期之间无相关性。
儿童肝脂肪变的特定组织学模式与脂肪性肝炎的组织学标志物相关。气球样变和门管区炎症与脂肪变特征具有良好的相关性。
