Dai Yi-Ning, Xu Cheng-Fu, Pan Hong-Ying, Huang Hai-Jun, Chen Mei-Juan, Li You-Ming, Yu Chao-Hui
Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China.
Center for General Practice Medicine, Department of Infectious Diseases, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China.
World J Clin Cases. 2022 May 6;10(13):4097-4109. doi: 10.12998/wjcc.v10.i13.4097.
Recently, nonalcoholic fatty liver disease (NAFLD) has been renamed metabolic-associated fatty liver disease (MAFLD). Based on the definition for MAFLD, a group of non-obese and metabolically healthy individuals with fatty liver are excluded from the newly proposed nomenclature.
To analyze the histologic features in the MAFLD and non-MAFLD subgroups of NAFLD.
Eighty-three patients with biopsy-proven NAFLD were separated into MAFLD and non-MAFLD groups. The diagnosis of MAFLD was established as hepatic steatosis along with obesity/diabetes or evidence of metabolic dysfunction. The histologic features were compared according to different metabolic disorders and liver enzyme levels.
MAFLD individuals had a higher NAFLD activity score ( = 0.002) and higher severity of hepatic steatosis (42.6% Grade 1, 42.6% Grade 2, and 14.8% Grade 3 in MAFLD; 81.8% Grade 1, 13.6% Grade 2, and 4.5% Grade 3 in non-MAFLD; = 0.007) than the non-MAFLD group. Lobular and portal inflammation, hepatic ballooning, fibrosis grade, and the presence of nonalcoholic steatohepatitis (NASH) and significant fibrosis were comparable between the two groups. The higher the liver enzyme levels, the more severe the grades of hepatic steatosis (75.0% Grade 1 and 25.0% Grade 2 in normal liver function; 56.6% Grade 1, 39.6% Grade 2, and 3.8% Grade 3 in increased liver enzyme levels; 27.8% Grade 1, 27.8% Grade 2, and 44.4% Grade 3 in liver injury; < 0.001). Patients with liver injury (alanine aminotransferase > 3 × upper limit of normal) presented a higher severity of hepatocellular ballooning ( = 0.021). Moreover, the grade of steatosis correlated significantly with hepatocellular ballooning degree ( = 0.338, = 0.002) and the presence of NASH ( = 0.466, < 0.001).
Metabolic dysfunction is associated with hepatic steatosis but no other histologic features in NAFLD. Further research is needed to assess the dynamic histologic characteristics in NAFLD based on the presence or absence of metabolic disorders.
最近，非酒精性脂肪性肝病（NAFLD）已被重新命名为代谢相关脂肪性肝病（MAFLD）。根据MAFLD的定义，一群非肥胖且代谢健康的脂肪肝患者被排除在新提出的命名法之外。
分析NAFLD的MAFLD和非MAFLD亚组的组织学特征。
83例经活检证实为NAFLD的患者被分为MAFLD组和非MAFLD组。MAFLD的诊断标准为肝脂肪变性伴肥胖/糖尿病或代谢功能障碍的证据。根据不同的代谢紊乱和肝酶水平比较组织学特征。
MAFLD患者的NAFLD活动评分更高（P = 0.002），肝脂肪变性的严重程度更高（MAFLD组中42.6%为1级，42.6%为2级，14.8%为3级；非MAFLD组中81.8%为1级，13.6%为2级，4.5%为3级；P = 0.007）。两组之间的小叶和门管区炎症、肝细胞气球样变、纤维化分级以及非酒精性脂肪性肝炎（NASH）和显著纤维化的存在情况相当。肝酶水平越高，肝脂肪变性的分级越严重（肝功能正常时75.0%为1级，25.0%为二级；肝酶水平升高时56.6%为1级，39.6%为2级，3.8%为3级；肝损伤时27.8%为1级，27.8%为2级，44.4%为3级；P < 0.001）。肝损伤患者（丙氨酸氨基转移酶>正常上限3倍）的肝细胞气球样变严重程度更高（P = 0.021）。此外，脂肪变性分级与肝细胞气球样变程度显著相关（P = 0.338，P = 0.002）以及与NASH的存在相关（P = 0.466，P < 0.001）。
代谢功能障碍与NAFLD中的肝脂肪变性相关，但与其他组织学特征无关。需要进一步研究以评估基于代谢紊乱的存在与否的NAFLD动态组织学特征。
