Manero E, Findor J A, Avagnina A, de Elizalde S, Elsner B
División de Gastroenterología, Hospital de Clínicas José de San Martín, Facultad de Medicina, Universidad de Buenos Aires.
Medicina (B Aires). 1994;54(6):625-9.
A prospective study of 21 patients with the diagnosis of non-alcoholic steatohepatitis (NASH) was carried out. All patients had hepatomegaly and in 10 (48%) image studies were consistent with steatosis and/or fibrosis. Biochemically, there was increase of AST, ALT and cholesterol in 48%, of GGT in 52% and of alkaline phosphatase in 38%. 18 patients were obese, 2 of them diabetic, 2 others had a history of exposure to drugs (amiodarone and isopropilic alcohol) and the last one presented hypothyroidism. Liver biopsies were studied using a semiquantitative scale to evaluate the degree of steatosis, inflammation and fibrosis in a scale from 1 to 3. Results showed a medium score of 2.6 for steatosis, 1.5 for inflammation and 1.8 for fibrosis. Four patients had cirrhosis and Mallory bodies were found in 11 cases (52%). NASH is an oligosymptomatic disease that can be found in different clinical conditions, mainly obesity, and is more frequent in women. It is histologically indistinguishable from alcoholic steatohepatitis. It is frequently underdiagnosed clinically and must be taken into account as a possible cause of cryptogenetic cirrhosis.
对21例诊断为非酒精性脂肪性肝炎(NASH)的患者进行了一项前瞻性研究。所有患者均有肝肿大,其中10例(48%)的影像学检查结果与脂肪变性和/或纤维化相符。生化检查方面,48%的患者谷草转氨酶(AST)、谷丙转氨酶(ALT)和胆固醇升高,52%的患者γ-谷氨酰转肽酶(GGT)升高,38%的患者碱性磷酸酶升高。18例患者肥胖,其中2例患有糖尿病,另外2例有药物(胺碘酮和异丙醇)接触史,最后1例患有甲状腺功能减退症。使用半定量量表对肝活检组织进行研究,以评估脂肪变性、炎症和纤维化程度,范围为1至3级。结果显示,脂肪变性的平均评分为2.6分,炎症为1.5分,纤维化为1.8分。4例患者有肝硬化,11例(52%)发现有马洛里小体。NASH是一种症状不明显的疾病,可在不同临床情况下出现,主要是肥胖,在女性中更为常见。其在组织学上与酒精性脂肪性肝炎无法区分。临床上它经常被漏诊,必须被视为不明原因肝硬化的可能病因。