Kleiner David E
Laboratory of Pathology, National Cancer Institute, Bethesda, MD, USA -
Minerva Gastroenterol Dietol. 2018 Mar;64(1):28-38. doi: 10.23736/S1121-421X.17.02445-X. Epub 2017 Sep 25.
Nonalcoholic fatty liver disease (NAFLD) is the liver disease associated with obesity, diabetes and the metabolic syndrome. Although steatosis is a key histological feature, liver biopsies of patients with NAFLD can show a wide range of other findings, including portal and lobular inflammation, ballooning and apoptotic hepatocellular injury, Mallory-Denk bodies, megamitochondria and fibrosis. Nonalcoholic steatohepatitis (NASH) is a progressive subtype of NAFLD first defined by analogy to alcoholic hepatitis. The characteristic finding in NASH is ballooning hepatocellular injury. The fibrosis pattern is distinctive, with perisinusoidal fibrosis around the central veins being the first manifestation of fibrosis. Young children may have an alternate pattern of progressive NAFLD characterized by a zone 1 distribution of steatosis, inflammation and fibrosis. Several grading and staging systems exist for use in natural history studies and clinical trials, each with some advantages and disadvantages. These include the Brunt system, the NASH CRN system and the SAF system. Each of these systems has been applied to clinical studies permitting correlation of laboratory and demographic observations with histological findings.
非酒精性脂肪性肝病（NAFLD）是一种与肥胖、糖尿病和代谢综合征相关的肝脏疾病。虽然脂肪变性是关键的组织学特征，但NAFLD患者的肝活检可显示出广泛的其他表现，包括门脉和小叶炎症、气球样变及凋亡性肝细胞损伤、马洛里-登克小体、巨型线粒体和纤维化。非酒精性脂肪性肝炎（NASH）是NAFLD的一种进行性亚型，最初是通过与酒精性肝炎类比而定义的。NASH的特征性表现是气球样变肝细胞损伤。纤维化模式独特，中央静脉周围的窦周纤维化是纤维化的首发表现。幼儿可能有一种不同的进行性NAFLD模式，其特征为脂肪变性、炎症和纤维化呈1区分布。有几种分级和分期系统用于自然史研究和临床试验，每种都有一些优缺点。这些系统包括布伦特系统、NASH CRN系统和SAF系统。这些系统中的每一个都已应用于临床研究，从而使实验室和人口统计学观察结果与组织学发现相关联。
