Division of Internal Medicine 2 and Center for Hemochromatosis, University of Modena and Reggio Emilia, Modena, Italy.
UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK.
Liver Int. 2019 Jul;39(7):1325-1334. doi: 10.1111/liv.14096. Epub 2019 Mar 27.
BACKGROUND & AIMS: Hyperferritinemia, with or without increased hepatic iron, represents a common finding in non-alcoholic fatty liver disease (NAFLD). However, it is unclear whether it reflects hepatic inflammation or true iron-overload and, in case the latter is confirmed, whether this influences disease progression. We therefore explored the association between serum ferritin, degree and pattern of hepatic iron deposition and liver disease severity in patients with NAFLD.
We selected 468 patients with biopsy-proven NAFLD from 2 European centres. Iron, hepatic and metabolic parameters were collected at the time of liver biopsy. Iron deposits in hepatocytes and reticuloendothelial cells were assessed and graded. Diagnosis of non-alcoholic steatohepatitis (NASH) and fibrosis staging were performed.
A total of 122 (26%) patients had hyperferritinemia, whereas stainable hepatic iron was found in 116 (25%) patients (38% predominantly in hepatocytes, 20% in reticuloendothelial cells and 42% in both). Subjects with stainable hepatic iron, particularly those with a mixed pattern, had higher serum ferritin and transaminases but only a mixed pattern of iron deposition was among the variables significantly associated with presence of NASH. Serum ferritin was not associated with presence of NASH, however it increased with worsening fibrosis stage (F3 compared to F0-F1), and significantly decreased in stage F4.
A mixed pattern of hepatic iron deposition is associated with the presence of steatohepatitis, while serum ferritin increases with worsening fibrosis up to pre-cirrhotic stage. In individual NAFLD patients, serum ferritin could be evaluated as part of non-invasive diagnostic panels but not on its own.
无论是否伴有肝铁增加，高血清铁蛋白血症均是非酒精性脂肪性肝病（NAFLD）的常见表现。但目前尚不清楚其反映的是肝炎症还是真正的铁过载，而在后者得到确认的情况下，是否会影响疾病进展。因此，我们探讨了 NAFLD 患者血清铁蛋白、肝铁沉积程度和模式与肝疾病严重程度之间的相关性。
我们从欧洲的 2 个中心选择了 468 例经肝活检证实的 NAFLD 患者。在肝活检时收集了铁、肝和代谢参数。评估并分级了肝细胞和网状内皮细胞中的铁沉积。进行了非酒精性脂肪性肝炎（NASH）的诊断和纤维化分期。
共有 122 例（26%）患者存在高血清铁蛋白血症，而 116 例（25%）患者存在可染色肝铁（38%主要在肝细胞中，20%在网状内皮细胞中，42%在两者中）。有可染色肝铁的患者，尤其是有混合模式的患者，血清铁蛋白和转氨酶更高，但只有混合模式的铁沉积是与存在 NASH 的变量显著相关。然而，血清铁蛋白与 NASH 的存在无关，但随着纤维化分期的恶化（F3 与 F0-F1 相比）而增加，并在 F4 阶段显著下降。
混合模式的肝铁沉积与肝炎的存在相关，而血清铁蛋白在纤维化进展到肝硬化前阶段会随着恶化而增加。在个体的 NAFLD 患者中，血清铁蛋白可作为非侵入性诊断组合的一部分进行评估，但不能单独评估。
