非酒精性脂肪性肝炎的临床病理研究

目的：探讨非酒精性脂肪性肝炎（Nonalcoholic steatohepatitis,NASH)的临床和病理学特征。方法：对40例NASH患者的临床资料和穿刺肝组织进行临床和病理学分析,并与酒精性脂肪性肝炎（Alcoholic steatohepatitis,ASH)和丙型肝炎（HCV）患者各20例作对照。结果：90％ NASH患者肥胖（P＜0．01）,血浆总蛋白平均水平高于ASH（P＜0．05）,血清ALT、AST、GGT、TBA、TG平均水平分别是正常范围上限值的2．6、1．5、1．2、1．3倍,但白蛋白水平是正常范围下限值的0．96倍。NASH的组织学改变类似ASH,但有些组织学改变如脂肪变性、汇管区的炎症程度,Mallory小体和空泡状核的出现频率等两者间存在着差异性（P＜0．05或P＜0．01）。NASH有其相对的病理特征：大小泡混合型脂肪变性,以大泡为主;肝组织气球样变性,小叶中央区较常见,气球样变性的细胞胞浆内常常有嗜碱性的细颗粒;肝小叶内炎症,不典型的Mallory小体,汇管区周围易见空泡状核细胞。多数NASH患者的肝小叶中央区（腺泡Ⅲk带）有不同程度的窦周纤维化。结论：结果显示NASH有一些相对的临床和病理学特征,临床、病理及实验室检查相结合能对NASH作出肯定的诊断,其中病理活检仍然是诊断NASH的“金标准”。

Clinical and pathological characteristics of nonalcoholic steatohepatitis

Objective To explore the clinicaland pathological characteristics of nonalcoholic steato-hepatitis (NASH). Methods The clinical and labo-ratory records and liver biopsy specimens of 40 caseswith NASH were composed to those of 20 patientswith ASH and hepatitis C. Results The rate of obe-sity was significantly higher in NASH than in ASH(P<0. 01 ), while the mean level of total protein inthe serum was higher in patients with NASH than inASH (P< 0. 05). The mean levels of serum ALT,AST, GGT, TBA and TG in the patients withNASH were as 2. 6, 1. 5, 1. 2, 1. 3 times as the up-per limit of the normal range and the ablumin was as0. 96 times as the low limit of the normal range. Thehistopathologic lesions in NASH were similar but notidentical to those of ASH. Significant difference werefound in the grade of steatosis, portal inflammation,Mallory bodies and nuclear vacuolation (P <0. 05 orP<0. 01). It was found that the common lesions ofNASH included steatosis (macro >micro), hepato-cyte ballooning degenertion, mild diffuse lobular in-flammation and perisinusodial collagen deposition,Mallory hyaline and vacuolated nuclei of periportalhepatocytes. Conclusions According to our find-ings, we could conclude that NASH had some clinicaland pathological characteristics; that combination ofclinics, pathology and laboratory could ensure the di-agnosis of NASH, and liver biopsy interpretation con-tinues to be considered the gold standard for diagno-sis.