Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Rua Alexander Fleming, S/No, Cidade Universitária Zeferino Vaz, SP, CEP 13085-000, Campinas, Brazil.
School of Medicine, Pontíficia Universidade Católica de Campinas (PUCCAMP), Campinas, Brazil.
Obes Surg. 2023 Mar;33(3):813-820. doi: 10.1007/s11695-023-06467-9. Epub 2023 Jan 24.
In non-alcoholic fatty liver disease (NAFLD), steatosis can manifest through two distinct forms: macrovesicular (macroS) and microvesicular (microS).
To investigate the prevalence of microS and its association with biochemical parameters and NAFLD-related histological findings in individuals with obesity.
This is an observational retrospective cross-sectional study, enrolling individuals who underwent bariatric surgery and liver biopsy at a university hospital. A 1:2 propensity matching was performed to pair microS with isolated macroS; this matching enrolled variables "age," "gender," "body mass index (BMI)," and "obesity-associated medical problems." Clinical, biochemical, and histopathological aspects were then analyzed and compared.
Of 115 participants, 88.7% were female; average age was 40.5 ± 5 years and mean BMI was 37.9 ± 3.3 kg/m. Steatosis occurred in 82.6% (67.8% isolated macroS and 14.8% microS). MicroS is significantly associated with higher levels of alanine aminotransferase (ALT) (39.8 ± 26.4 vs. 26.7 ± 17.5; p = 0.04) and glucose (103.8 ± 52.6 vs. 83.3 ± 10.8; p = 0.03) and higher frequencies of moderate to severe macroS (41.2% vs. 2.0%; p < 0.001), portal fibrosis (100% vs. 50%; p < 0.001), perisinusoidal fibrosis (100% vs. 55.9%; p < 0.001), lobular inflammation (100% vs. 41.1%; p < 0.001), and portal inflammation (100% vs. 41.1%; p < 0.001). An independently positive association was observed between intensities of microS and macroS (p < 0.001).
MicroS is significantly associated with higher levels of ALT and glucose and higher frequencies of moderate to severe macroS, hepatocellular ballooning, portal fibrosis, perisinusoidal fibrosis, lobular inflammation, and portal inflammation. These findings indicate that microS could be considered a reliable histological marker of NAFLD severity.
在非酒精性脂肪性肝病（NAFLD）中，脂肪变性可以通过两种不同的形式表现出来：大泡性（macrovesicular，macroS）和小泡性（microvesicular，microS）。
研究肥胖个体中小泡性脂肪变性的患病率及其与生化参数和与 NAFLD 相关的组织学发现的关系。
这是一项观察性回顾性病例对照研究，纳入了在一所大学医院接受减肥手术和肝活检的患者。采用 1:2 倾向评分匹配将 microS 与孤立的 macroS 进行配对；该匹配纳入了变量“年龄”、“性别”、“体重指数（BMI）”和“肥胖相关的医疗问题”。然后分析和比较了临床、生化和组织病理学方面。
在 115 名参与者中，88.7%为女性；平均年龄为 40.5±5 岁，平均 BMI 为 37.9±3.3kg/m2。脂肪变性发生率为 82.6%（单纯 macroS 为 67.8%，microS 为 14.8%）。microS 与丙氨酸氨基转移酶（ALT）水平升高显著相关（39.8±26.4 与 26.7±17.5；p=0.04）和葡萄糖（103.8±52.6 与 83.3±10.8；p=0.03），且中重度 macroS 的频率更高（41.2%与 2.0%；p<0.001）、门脉纤维化（100%与 50%；p<0.001）、窦周纤维化（100%与 55.9%；p<0.001）、小叶炎症（100%与 41.1%；p<0.001）和门脉炎症（100%与 41.1%；p<0.001）。microS 与 macroS 之间存在独立的正相关关系（p<0.001）。
microS 与 ALT 和葡萄糖水平升高以及中重度 macroS、肝细胞气球样变、门脉纤维化、窦周纤维化、小叶炎症和门脉炎症的频率较高显著相关。这些发现表明，microS 可以作为 NAFLD 严重程度的可靠组织学标志物。
