Kocabay G, Telci A, Tutuncu Y, Tiryaki B, Ozel S, Cevikbas U, Okten A, Satman I
Department of Endocrinology, Faculty of lstanbul Medicine, Istanbul University, Istanbul, Turkey.
Bratisl Lek Listy. 2011;112(11):626-9.
While isolated hepatosteatosis is a benign disease, in minority of cases non-alcoholic steatohepatitis (NASH) may even lead to cirrhosis in long-term. In order to find the stage of the disease and determine the prognosis, a liver biopsy is indicated. In this study, we studied the relationship of liver histopathological findings with serum levels of hepatic enzymes.
We recruited 52 cases of NASH with Type 2 diabetes mellitus. Diagnosis of NASH was made based on biochemical tests, ultrasound images and liver biopsy.
Steatosis was mild in 57.7%, moderate in 30.8%, and severe in 11.6% of patients. While no infiltration was found in 78.8% of cases, there was a grade-1 infiltration in 15.4% and a grade-2 infiltration in 5.8% of cases. Similarly, no fibrosis was found in 42.3% of patients, but there was a stage-1 fibrosis in 50%, and a stage-2 fibrosis in 7.7% of cases. In patients with severe steatosis, serum levels of AST were higher than mild or moderate stage steatosis. Accordingly, in patients with no inflammation, serum levels of ALT were higher than in patients with inflammation. However, in patients with fibrosis, triglycerides levels were significantly lower and ALP was significantly higher than in patients without fibrosis. The correlation analysis indicated a positive association between serum levels of ALP and C-peptide.
In addition to conventional risk factors such as age, presence of diabetes, female sex; higher levels of ALP may be considered as a risk factor linked to hepatic fibrosis in patients with NASH and type 2 diabetes (Tab. 6, Ref. 8).
虽然孤立性肝脂肪变性是一种良性疾病，但在少数情况下，非酒精性脂肪性肝炎（NASH）长期甚至可能导致肝硬化。为了确定疾病阶段并判断预后，需要进行肝活检。在本研究中，我们研究了肝脏组织病理学结果与血清肝酶水平之间的关系。
我们招募了52例2型糖尿病合并NASH的患者。NASH的诊断基于生化检查、超声图像和肝活检。
57.7%的患者脂肪变性为轻度，30.8%为中度，11.6%为重度。78.8%的病例未发现浸润，15.4%的病例为1级浸润，5.8%的病例为2级浸润。同样，42.3%的患者未发现纤维化，但50%的病例为1期纤维化，7.7%的病例为2期纤维化。重度脂肪变性患者的血清AST水平高于轻度或中度脂肪变性患者。因此，无炎症患者的血清ALT水平高于有炎症患者。然而，有纤维化患者的甘油三酯水平显著低于无纤维化患者，而碱性磷酸酶（ALP）水平显著高于无纤维化患者。相关性分析表明血清ALP水平与C肽之间呈正相关。
除了年龄、糖尿病、女性等传统风险因素外；较高的ALP水平可能被视为NASH合并2型糖尿病患者肝纤维化的一个风险因素（表6，参考文献8）。
