Losekann Alexandre, Weston Antonio Carlos, Carli Luis Alberto de, Espindola Marilia Bittencourt, Pioner Sergio Ricardo, Coral Gabriela Perdomo
Programa de Pós-Graduação em Hepatologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto AlegreRS, Brasil.
Centro de Tratamento da Obesidade, Hospital Santa Casa de Misericórdia de Porto Alegre, Porto AlegreRS, Brasil.
Arq Gastroenterol. 2013 Oct-Dec;50(4):285-9. doi: 10.1590/S0004-28032013000400009.
Nonalcoholic fatty liver disease encompasses a spectrum of histopathological changes that range from simple steatosis to nonalcoholic steatohepatitis. Works suggest that iron (Fe) deposits in the liver are involved in the physiopathology of nonalcoholic steatohepatitis.
The aim of this study was to determine the prevalence of simple steatosis and nonalcoholic steatohepatitis in patients with morbid obesity, subjected to bariatric surgery and to establish a correlation of the anatomopathological findings with the presence of liver fibrosis.
A total of 250 liver biopsies were conducted in the transoperation of the surgeries.
Steatosis was present in 226 (90.4%) of the samples, 76 (30.4%) being classified as mild; 71 (28.4%) as moderate and 79 (31.6%) as intense. Nonalcoholic steatohepatitis was diagnosed in 176 (70.4%) cases, where 120 (48.4%) were mild; 50 (20%) were moderate, and 6 (2.4%) cases were intense. Fibrosis was referred to in 108 (43.2%) biopsies, 95 of which (38%) were mild; 2 (0.8%) were moderate; 7 (2.8%) were intense, and cirrhosis was diagnosed in 4 (1.6%) cases. There was a correlation between the degree of steatosis and the level of inflammatory activity (rs = 0.460; P<0.001) and between the degree of this activity and the degree of fibrosis (rs = 0.583; P<0.001). Only 13 (5.2%) samples showed Fe deposits.
There is a high prevalence of nonalcoholic steatohepatitis in these patients and a positive correlation of the degrees of nonalcoholic steatohepatitis with the intensity of fibrosis. The low prevalence of Fe deposits found makes it questionable that the presence of this ion has any participation in the physiopathogeny of nonalcoholic fatty liver disease.
非酒精性脂肪性肝病涵盖了一系列组织病理学变化，从单纯性脂肪变性到非酒精性脂肪性肝炎。研究表明，肝脏中的铁（Fe）沉积参与了非酒精性脂肪性肝炎的病理生理过程。
本研究旨在确定接受减肥手术的病态肥胖患者中单纯性脂肪变性和非酒精性脂肪性肝炎的患病率，并建立解剖病理学结果与肝纤维化存在之间的相关性。
在手术过程中总共进行了250次肝活检。
226份（90.4%）样本存在脂肪变性，其中76份（30.4%）为轻度；71份（28.4%）为中度；79份（31.6%）为重度。176例（70.4%）诊断为非酒精性脂肪性肝炎，其中120例（48.4%）为轻度；50例（20%）为中度，6例（2.4%）为重度。108份（43.2%）活检提及纤维化，其中95份（38%）为轻度；2份（0.8%）为中度；7份（2.8%）为重度，4例（1.6%）诊断为肝硬化。脂肪变性程度与炎症活动水平之间存在相关性（rs = 0.460；P<0.001），且该活动程度与纤维化程度之间也存在相关性（rs = 0.583；P<0.001）。仅13份（5.2%）样本显示有铁沉积。
这些患者中非酒精性脂肪性肝炎的患病率很高，且非酒精性脂肪性肝炎程度与纤维化强度呈正相关。所发现的低铁沉积患病率使得该离子是否参与非酒精性脂肪性肝病的病理发生过程存疑。
