非酒精性脂肪性肝病的组织病理学和生物化学特征与肥胖个体肝纤维化严重程度的相关性：横断面研究。
Association of Histopathological and Biochemical Aspects of NAFLD With the Severity of Liver Fibrosis in Individuals With Obesity: Cross-sectional Study.
机构信息
Dept. of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Rua Alexander Fleming, S/No Cidade Universitária Zeferino Vaz, Campinas, SP, CEP 13085-000, Brazil.
出版信息
Obes Surg. 2024 May;34(5):1569-1574. doi: 10.1007/s11695-024-07180-x. Epub 2024 Mar 19.
BACKGROUND
Given the importance of fibrosis in the progression of non-alcoholic fatty liver disease (NAFLD), identifying biochemical and histopathological aspects associated with its severity is important to determine the course of disease in high-risk populations.
OBJECTIVES
The study aims to investigate correlations between biochemical and histopathological variables associated with the occurrence and severity of NAFLD-related liver fibrosis in individuals with obesity.
METHODS
This is a cross-sectional study which enrolled 171 individuals who underwent bariatric surgery at a tertiary university hospital. Clinical, laboratory, and histopathological hepatic characteristics were analyzed. Univariate and multivariate analyses were carried out to identify factors associated with the outcomes studied (severity of fibrosis staging) through simple and multiple regression models.
RESULTS
Female were 87.7%, and the mean age was 38.4 ± 9.3 years. The most common histopathological abnormalities were macrovesicular steatosis (74.9%) and hepatocellular ballooning (40.4%). In the histopathological univariate analysis, liver fibrosis significantly correlated with severities of microvesicular steatosis (p = 0.003), lobular inflammation (p = 0.001), and NAS (p < 0.001). In the multivariate analysis, the degrees of microvesicular steatosis (p < 0.001) and NAS (p < 0.001) independently correlated with fibrosis severity. In the univariate biochemical analysis, fibrosis severity significantly correlated with levels of hemoglobin A1c (p = 0.004) and glucose (p = 0.01). In the multivariate analysis, glucose levels independently correlated with liver fibrosis degree (p = 0.007).
CONCLUSION
Significant and independent associations were observed between the intensities of microvesicular steatosis, NAS, and glucose levels and the severity degree of liver fibrosis in individuals with obesity.
背景
鉴于纤维化在非酒精性脂肪性肝病（NAFLD）进展中的重要性，确定与纤维化严重程度相关的生化和组织病理学特征对于确定高危人群的疾病进程非常重要。
目的
本研究旨在探讨肥胖个体中与 NAFLD 相关肝纤维化发生和严重程度相关的生化和组织病理学变量之间的相关性。
方法
这是一项横断面研究，共纳入 171 名在三级大学医院接受减肥手术的个体。分析了临床、实验室和组织病理学肝特征。通过简单和多元回归模型进行了单变量和多变量分析，以确定与研究结果（纤维化分期严重程度）相关的因素。
结果
女性占 87.7%，平均年龄为 38.4±9.3 岁。最常见的组织病理学异常是大泡性脂肪变性（74.9%）和肝细胞气球样变（40.4%）。在组织病理学单变量分析中，肝纤维化与微泡性脂肪变性严重程度（p=0.003）、小叶炎症（p=0.001）和 NAS（p<0.001）显著相关。在多元分析中，微泡性脂肪变性程度（p<0.001）和 NAS（p<0.001）与纤维化严重程度独立相关。在单变量生化分析中，纤维化严重程度与血红蛋白 A1c（p=0.004）和血糖（p=0.01）水平显著相关。在多元分析中，血糖水平与肝纤维化程度独立相关（p=0.007）。
结论
在肥胖个体中，微泡性脂肪变性强度、NAS 和血糖水平与肝纤维化严重程度之间存在显著的独立关联。
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