Büyük Melek, Berker Neslihan, Bağbudar Sidar, Çavuş Bilger, Güllüoğlu Mine
Department of Pathology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
Department of Gastroenterology and Hepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
Medicine (Baltimore). 2025 Apr 11;104(15):e42108. doi: 10.1097/MD.0000000000042108.
Metabolic dysfunction-associated steatotic liver disease (MASLD) spectrum encompasses steatosis, metabolic dysfunction-associated steatohepatitis, fibrosis, cirrhosis and metabolic dysfunction-associated steatohepatitis-related hepatocellular carcinoma. We evaluated the histomorphologic findings, portal-periportal biliary epithelial cell changes, and factors that may be associated with the degree of fibrosis in liver biopsies of MASLD patients. Hematoxylin-eosin, masson-trichrome, keratin7, keratin19, CD34, and glutamine synthetase-stained biopsies of 34 patients and 10 healthy liver donors (as controls) were retrospectively analyzed. Lobular inflammation was significantly correlated to the ballooning degeneration (P = .023), portal inflammation (P = .003), ductular reaction (DR) grade (P = .027), and the degree of fibrosis (P = .003). Ballooning degeneration (P = .004), and NAS (P = .008) were significantly related to the degree of fibrosis. Portal inflammation had a significant relationship with both DR grade (P < .001) and the degree of fibrosis (P = .002). The presence of hepatic progenitor cells (HPCs) was related to NAS (P = .005) and correlated with the DR grade (P = .002) and the degree of fibrosis (P = .038). Both DR (P < .001) and biliary metaplasia (P = .024) were significantly correlated with the degree of fibrosis. In multivariate analysis, biliary metaplasia (P = .015) and DR (P = .02) were found to be independent factors related to degree of fibrosis. Our results showed that HPC and DR were closely associated with disease activity and degree of fibrosis and might be good indicators of disease progression in MASLD. As pathologists, we might integrate the degree of HPCs and the grade of DR in our pathology reports as these findings might contribute to the disease progression risk categorization of the patients.
代谢功能障碍相关脂肪性肝病（MASLD）谱系包括脂肪变性、代谢功能障碍相关脂肪性肝炎、纤维化、肝硬化以及代谢功能障碍相关脂肪性肝炎相关肝细胞癌。我们评估了MASLD患者肝活检的组织形态学表现、门周胆管上皮细胞变化以及可能与纤维化程度相关的因素。对34例患者和10例健康肝脏供体（作为对照）的苏木精-伊红、马松三色、角蛋白7、角蛋白19、CD34和谷氨酰胺合成酶染色的活检标本进行了回顾性分析。小叶炎症与气球样变性（P = 0.023）、门管区炎症（P = 0.003）、小胆管反应（DR）分级（P = 0.027）以及纤维化程度（P = 0.003）显著相关。气球样变性（P = 0.004）和NAS（P = 0.008）与纤维化程度显著相关。门管区炎症与DR分级（P < 0.001）和纤维化程度（P = 0.002）均有显著关系。肝祖细胞（HPC）的存在与NAS（P = 0.005）相关，并与DR分级（P = 0.002）和纤维化程度（P = 0.038）相关。DR（P < 0.001）和胆管化生（P = 0.024）均与纤维化程度显著相关。在多变量分析中，发现胆管化生（P = 0.015）和DR（P = 0.02）是与纤维化程度相关的独立因素。我们的结果表明，HPC和DR与疾病活动度和纤维化程度密切相关，可能是MASLD疾病进展的良好指标。作为病理学家，我们可能会在病理报告中纳入HPC的程度和DR的分级，因为这些发现可能有助于对患者的疾病进展风险进行分类。
