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目的研究非酒精性脂肪性肝病(NAFLD)的临床与病理特征。方法分析41例NAFLD患者的肝组织脂肪变程度、炎症分级和纤维化分期,并研究其与体重指数(BMI)、血清生物化学和B超检查结果的关系。结果41 例NAFLD患者中,肝组织脂肪变分级:Ⅰ级21例(51．2％),Ⅱ级15例(36．6％),Ⅲ级5例(12．2％);肝组织炎症活动度分级:G0级2例(4．9％),G1级25例(61．0％),G2级10例(24．4％),G3级3例(7．3％),G4级1例(2．4％); 肝组织纤维化分期:S0期20例(48．8％),S1期14例(34．2％),S2期4例(9．8％),S3期2例(4．9％),S4期1例(2．4％)。肝脂肪变程度与肝炎症分级(r=-0．131 3,P=0．413)和肝纤维化分期(r=-0．179 2,P=0．262 3)均无显著的相关性。肝细胞脂肪变程度与BMI(r=0．669,P<0．01)和B超检测到的脂肪肝程度(r=0．366,P<0．01) 呈正相关,炎症活动度与丙氨酸氨基转移酶(ALT)(r=0．669,P=0．019)、天冬氨酸氨基转移酶(AST)(r= 0．438,P=0．005)和B超检测到的脂肪肝程度(r=0．562,P<0．001)呈正相关,而与血小板数呈负相关(r= -0．344,P=0．040);肝纤维化分期与ALT(r=0．449,P=0．003)、AST(r=0．477,P=0．002)、γ-谷氨酰转肽酶(r=0．373,P=0．025)和碱性磷酸酶(r=0．346,P=0．039)呈正相关,而与甘油三酯(r=-0．324, P=0．042)和血小板数(r=-0．375,P=0．024)呈负相关。结论肝脂肪变程度与炎症分级和肝纤维化分期均无显著的相关性,BMI、AST、ALT、血小板和B超检测到的脂肪肝程度等与肝组织病理学有关,肝活组织检查有助于明确诊断。
Objective To study the clinical and pathological features of nonalcoholic fatty liver disease (NAFLD). Methods The degree of fatty liver, grade of inflammation and fibrosis stage in 41 patients with NAFLD were analyzed, and their relationship with body mass index (BMI), serum biochemistry and B - ultrasound findings were also studied. Results Among the 41 NAFLD patients, the grade of steatosis was grade Ⅰ in 21 cases (51.2%), grade Ⅱ in 15 cases (36.6%) and grade Ⅲ in 5 cases (12.2%). The liver tissue inflammatory activity Degree grading: 2 cases (4.9%) in G0 class, 25 cases (61.0%) in G1 class, 10 cases (24.4%) in G2 class, 3 cases (7.3%) in G3 class, (2.4%). The staging of liver fibrosis was 20 (48.8%) in S0, 14 (34.2%) in S1, 4 (9.8%) in S2, Cases (4.9%), S4 one case (2.4%). There was no significant correlation between hepatic steatosis and hepatic inflammation grade (r = -0.131 3, P = 0.413) and liver fibrosis stage (r = -0.179 2, P = 0.262 3) . The degree of steatosis of hepatocytes was positively correlated with the level of fatty liver detected by BMI (r = 0.669, P <0.01) and B-ultrasound (r = 0.366, P <0.01) ALT (r = 0.669, P = 0.019), aspartate aminotransferase (AST) (r = 0.438, P = 0.005) (R = -0.344, P = 0.040). The staging of liver fibrosis was positively correlated with ALT (r = -0.344, P = 0.040) (R = 0.477, P = 0.002), γ-glutamyl transpeptidase (r = 0.373, P = 0.025) and base (R = -0.324, P = 0.042) and platelet count (r = -0.375, P = 0.024) was negatively correlated. Conclusions There is no significant correlation between the degree of steatosis and the grade of inflammation and the stage of hepatic fibrosis. The levels of BMI, AST, ALT, fatty liver detected by platelet and B-ultrasonography are correlated with liver histopathology. Liver biopsy can be helpful In a clear diagnosis.