Monteiro Juliana Maya, Monteiro Geysa Maya, Caroli-Bottino Adriana, Pannain Vera Lucia
Postgraduate Program, Department of Pathology, University Hospital, Faculty of Medicine, Federal University of Rio de Janeiro, Avenida Prof. Rodolpho Paulo Rocco 255, Cidade Universitária, 21941-913 Rio de Janeiro, RJ, Brazil.
Faculty of Medicine, Severino Sombra University, Avenida Expedicionário Oswaldo de Almeida Ramos 280, Centro, 27700-000 Vassouras, RJ, Brazil.
Anal Cell Pathol (Amst). 2014;2014:526979. doi: 10.1155/2014/526979. Epub 2014 Dec 2.
The morphological features of nonalcoholic fatty liver disease (NAFLD) range from steatosis to nonalcoholic steatohepatitis (NASH) and cirrhosis. Liver biopsy remains the main tool for NASH diagnosis and many histological systems to diagnose and grade NAFLD were proposed. We evaluated the relationship among NAFLD activity score (NAS), histological diagnoses (non-NASH, possible NASH, and definite NASH), and histological algorithm proposed by Bedossa et al.; additionally the degrees of morphological features were semiquantified and correlated with non-NASH and NASH. Seventy-one liver biopsies were studied. The agreement among the three systems considering NASH and non-NASH was excellent (Κ = 0.96). Among the 22 biopsies with NAS 3-4, 72.7% showed to be NASH according to Bedossa's algorithm. The degree of steatosis, ballooning, lobular inflammation, and fibrosis stage were correlated with NASH (P < 0.001). Fibrosis stage 1 was also found in non-NASH. Over the spectrum of NAFLD, no association was observed between intensity of steatosis and fibrosis grade. The degrees of lobular inflammation showed association with fibrosis stage (P < 0.0001). In conclusion, there is agreement among different NAFLD classifications and NAS > 4 may be a better cutoff from which to consider NASH diagnosis; besides the highest degrees of steatosis, ballooning, inflammation, and fibrosis are associated with NASH.
非酒精性脂肪性肝病（NAFLD）的形态学特征范围从脂肪变性到非酒精性脂肪性肝炎（NASH）和肝硬化。肝活检仍然是NASH诊断的主要工具，并且已经提出了许多用于诊断和分级NAFLD的组织学系统。我们评估了NAFLD活动评分（NAS）、组织学诊断（非NASH、可能的NASH和明确的NASH）以及Bedossa等人提出的组织学算法之间的关系；此外，对形态学特征的程度进行了半定量，并与非NASH和NASH进行了相关性分析。对71例肝活检进行了研究。考虑NASH和非NASH的三种系统之间的一致性非常好（Κ = 0.96）。在NAS为3 - 4的22例活检中，根据Bedossa算法，72.7%显示为NASH。脂肪变性、气球样变、小叶炎症和纤维化阶段的程度与NASH相关（P < 0.001）。在非NASH中也发现了1期纤维化。在NAFLD的整个范围内，未观察到脂肪变性强度与纤维化分级之间的关联。小叶炎症程度与纤维化阶段相关（P < 0.0001）。总之，不同的NAFLD分类之间存在一致性，NAS > 4可能是考虑NASH诊断的更好切点；除了最高程度的脂肪变性、气球样变、炎症和纤维化与NASH相关外。
