Ergenc Ilkay, Kara Erdogan, Yilmaz Muhammed Emre, Demirtas Coskun Ozer, Keklikkiran Caglayan, Das Taner, Buyuk Yalcin, Celikel Cigdem, Asliyuksek Hizir, Yilmaz Yusuf
Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Türkiye.
Institute of Liver Studies, King's College Hospital, London, UK.
Heliyon. 2024 Jul 20;10(15):e34915. doi: 10.1016/j.heliyon.2024.e34915. eCollection 2024 Aug 15.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global epidemic in Türkiye and worldwide. The aim of this study was to evaluate the prevalence and predictors of MASLD and steatohepatitis among adults who died of unnatural causes including sudden death and non-burn trauma.
We conducted a prospective review of all consecutive adult forensic autopsies for natural (sudden unexpected) and non-natural (Suicidal, homicidal and accidental) suspicious deaths carried out at the Istanbul Council of Forensic Medicine from February to May 2022. Four wedge biopsies were extracted from sagittal sectioned liver specimens. A liver pathologist with 20 years of experience examined each case for steatosis, ballooning, inflammation, and fibrosis.
Among 1797 autopsies, 62 met inclusion criteria. Overall, 43.3 % (n = 26) of autopsies showed evidence of steatotic liver disease, with a distribution of steatosis severity as: Grade I (28.3 %), Grade II (6.6 %), and Grade III (8.3 %). All these cases met at least one cardiometabolic criteria and diagnosed with MASLD. Ballooning was observed in 20.0 % of cases (5 cases grades 1 and 7 cases grade 2), and Inflammation was present in 51.7 % (9 cases with grade 0-1, 12 with 1-2, 7 with 2-3, and 3 with 5-6). Notably, 46.1 % (n = 12) of MASLD cases and 20.0 % (n = 12) of all cases were diagnosed with steatohepatitis, with three cases exhibiting delicate perisinusoidal fibrosis and one case showing portal fibrosis.
The histopathological findings from this autopsy study confirmed the markedly high prevalence of MASLD and steatohepatitis within the general adult population, highlighting the concerning burden of steatotic liver disease in Türkiye.
代谢功能障碍相关脂肪性肝病（MASLD）在土耳其乃至全球都是日益严重的流行病。本研究的目的是评估在包括猝死和非烧伤创伤在内的非自然原因死亡的成年人中，MASLD和脂肪性肝炎的患病率及预测因素。
我们对2022年2月至5月在伊斯坦布尔法医委员会进行的所有连续成人法医尸检进行了前瞻性回顾，这些尸检涉及自然（意外猝死）和非自然（自杀、他杀和意外）可疑死亡案例。从矢状切开的肝脏标本中提取了4块楔形活检组织。一位有20年经验的肝脏病理学家对每个病例进行脂肪变性、气球样变、炎症和纤维化检查。
在1797例尸检中，62例符合纳入标准。总体而言，43.3%（n = 26）的尸检显示有脂肪性肝病证据，脂肪变性严重程度分布为：I级（28.3%）、II级（6.6%）和III级（8.3%）。所有这些病例均符合至少一项心脏代谢标准，并被诊断为MASLD。20.0%的病例（5例1级和7例2级）观察到气球样变，51.7%（9例0 - 1级、12例1 - 2级、7例2 - 3级和3例5 - 6级）存在炎症。值得注意的是，46.1%（n = 12）的MASLD病例和20.0%（n = 12）的所有病例被诊断为脂肪性肝炎，3例表现为纤细的窦周纤维化，1例表现为门脉纤维化。
这项尸检研究的组织病理学结果证实，MASLD和脂肪性肝炎在普通成年人群中的患病率显著较高，凸显了土耳其脂肪性肝病令人担忧的负担。
