非酒精性脂肪性肝炎病理病因和发病机制

非酒精性脂肪性肝炎(non-alcoholic steatohepatitis,NASH)是以无过量饮酒史(或酒精摄入量<20 g/d)以及肝细胞脂肪变性、气球样变、弥散性肝小叶轻度炎症和(或)肝中央静脉、肝窦周围胶原沉积等为临床-病理特征的慢性肝脏疾病.NASH一词提示,肝脏在脂肪变性的基础上有炎症表现.肝细胞脂肪变性的病因多种多样,而肝脏病理是从脂肪变性、不伴或伴有炎症,甚至到胶原沉积等变化由少到多,程度由轻到重的渐进过程.因此,NASH被认为是非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)或非酒精性脂肪性变综合征(non-alcoholic steatosis syndrome)中一种较重的临床类型.在我国,酒精性脂肪性肝炎发病率较欧美国家低,因此,NASH的发病率相对较高.     

非酒精性脂肪性肝炎中医诊疗指南

<正>非酒精性脂肪性肝病包括非酒精性肝脂肪变、非酒精性脂肪性肝炎、肝硬化、肝细胞癌。非酒精性脂肪性肝炎是在非酒精性肝脂肪变基础上形成的,出现血清生化酶学超过正常值上限,或(和)肝穿刺病理组织学显示肝细胞脂肪变>5%,伴有炎症及肝细胞损伤(如气球样变),     

非酒精性脂肪性肝炎中医诊疗指南

<正>非酒精性脂肪性肝病包括非酒精性肝脂肪变、非酒精性脂肪性肝炎、肝硬化、肝细胞癌。非酒精性脂肪性肝炎是在非酒精性肝脂肪变基础上形成的，出现血清生化酶学超过正常值上限，或/和肝穿刺病理组织学显示肝细胞脂肪变> 5%，伴有炎症及肝细胞损伤(如气球样变)，并除外导致肝脂肪变的其他原因，如大量饮酒、长期应用促脂肪形成药物或单基因遗传紊乱等的疾病^[1]。     

非酒精性脂肪性肝病的流行病学和自然史特征

非酒精性脂肪性肝病（nonalcoholic fatty liver disease，NAFLD）指除外酒精和其他明确的肝损害因素所致的、以弥漫性肝细胞大泡性脂肪变为主要特征的临床病理综合征，包括单纯性脂肪肝以及由其演变的非酒精性脂肪性肝炎（nonalcoholic steatohepatitis，NASH）、肝硬化。单纯性脂肪肝指肝细胞脂肪变而没有组织学损害的证据；NASH指肝脏脂肪变伴随相关的炎症及肝细胞损害，肝纤维化不是NASH的必要条件。     

2015非酒精性脂肪性肝病研究现状

<正>非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)是指除外酒精和其他明确肝损害因素的以弥漫性肝细胞脂肪变为主要特征的临床病理综合征,包括单纯性非酒精性脂肪变性(simple non-alcoholic steatosis,NAS)、非酒精性脂肪性肝炎(non-alcoholic steatohepattis,NASH)和NASH相关肝硬化。NAFLD呈全球流行趋势,目前已成为发达国家慢性     

第六讲 非酒精性脂肪性肝炎病理病因和发病机制

非酒精性脂肪性肝炎 (ｎｏｎ ａｌｃｏｈｏｌｉｃｓｔｅａｔｏｈｅｐａｔｉｔｉｓ,ＮＡＳＨ)是以无过量饮酒史 (或酒精摄入量 <2 0 ｇ/ｄ)以及肝细胞脂肪变性、气球样变、弥散性肝小叶轻度炎症和 (或 )肝中央静脉、肝窦周围胶原沉积等为临床 病理特征的慢性肝脏疾病。ＮＡＳＨ一词提示 ,肝脏在脂肪变性的基础上有炎症表现。肝细胞脂肪变性的病因多种多样 ,而肝脏病理是从脂肪变性、不伴或伴有炎症 ,甚至到胶原沉积等变化由少到多 ,程度由轻到重的渐进过程。因此 ,ＮＡＳＨ被认为是非酒精性脂肪性肝病 (ｎｏｎ ａｌｃｏｈｏｌｉｃｆａｔｔｙ…     

2012年脂肪性肝病诊疗进展

脂肪性肝病(fatty liver disease,FLD)是一组以肝细胞大泡性脂肪变为病理特征并可进展为脂肪性肝炎和肝硬化的异质性疾病,包括酒精性肝病(ALD)、非酒精性脂肪性肝病(NAFLD)以及特殊原因所致脂肪肝等三大类型[1-2].随着人口老龄化和病毒性肝炎的有效防治以及肥胖症和酒精滥用的广泛流行,已成为终末期肝病的重要原因并导致FLD患者愈来愈多[1-4].此外,糖脂毒性和酒精滥用与其他损肝因素合并存在时,可促进慢性病毒性肝炎和原发性血色病的发生和发展;脂肪沉积的肝脏对药物和工业毒物以及缺血缺氧的耐受性下降,容易发生中毒性和缺血性肝损害;脂肪肝作为供体易发生原发性移植肝无功能,中重度脂肪肝患者肝脏大手术后并发症和死亡率增高;NAFLD及其严重类型非酒精性脂肪性肝炎(NASH)与2型糖尿病互为因果且增加恶性肿瘤和动脉硬化性心脑血管疾病发病率[1-6].     

细胞色素P450家族与非酒精性脂肪肝的关系

正非酒精性脂肪肝(nonalcoholic fatty liver disease,NAFLD)是我国最常见的慢性肝病。它是指除外酒精和其他明确的肝损害因素所致的,以弥漫性肝细胞大泡性脂肪变为主要特性的临床病理综合征。NAFLD在临床上主要包括单纯性脂肪变(simple steatosis,SS)、脂肪性肝炎(nonalcoholic steatohepatitis,NASH)、脂肪性肝纤维化、肝硬化和肝癌。在世界范围内,成年人NAFLD患病率可达30%,在糖尿病患者和肥胖群体中,NAFLD患病率更高达70%~80%,严重威胁     

重视代谢相关脂肪性肝病的特征与预后临床研究

非酒精性脂肪性肝病(NAFLD)是与胰岛素抵抗和遗传易感密切相关的以肝细胞大泡性脂肪变为病理特征的慢性代谢应激性肝脏疾病,疾病谱主要包括非酒精性单纯性脂肪肝、非酒精性脂肪性肝炎(NASH)及其相关的肝硬化和肝细胞癌(HCC)[1] .     

非酒精性脂肪肝与代谢综合征

非酒精性脂肪肝是一种慢性的病理状态，它实际上包含了肝脏损害的多种疾病谱，如单纯的肝脏脂肪变性、非酒精性脂肪性肝炎、进展性肝纤维化及肝硬化等。代谢综合征在一般人群中很常见，尤其多见于某些高危人群，包括非酒精性脂肪肝患者，本文就这两种状态及其相互间的关系作一综述。     

1571例肝活检患者病因与肝组织病理学特点分析

目的：探讨肝活检患者的病因分布与组织病理学变化特点。方法收集2007年～2013年我科行肝脏穿刺活检诊断的非肿瘤性病变1571例,分析疾病的病因构成及主要疾病的病理学特点。结果本组肝脏穿刺活检组织诊断的非肿瘤性病变前五位的病因构成依次为病因不能明确（73.6%）、乙型肝炎（10.0%）、脂肪肝（7.4%）、原发性胆汁性肝硬化（4.1%）和慢性丙型肝炎（1.6%）;在病因不能明确的患者通常为其它脏器的病损而导致的肝脏非特异性病损;乙型肝炎临床主要表现为乏力、食欲不振和黄疸等症状,病理学特征主要为肝细胞毛玻璃样改变、水肿和点灶状坏死等;多种病因可引起肝细胞脂肪变,诊断脂肪肝要在排除其它因素的同时需结合易感因素进行诊断;原发性胆汁性肝硬化表现为小胆管慢性非化脓性破坏;丙型肝炎大多无临床症状,病理特征主要为肝细胞水肿、脂肪变性、纤维组织增生和汇管区淋巴细胞浸润等。结论病因不能明确、乙型肝炎、脂肪肝、原发性胆汁性肝硬化和慢性丙型肝炎是肝穿刺后主要的病理学诊断,其临床和肝组织学表现各有其特征可供参考。     

Exacerbation of Sickle Cell Disease Itself as a Cause of Abnormal Liver Chemistry Tests

Liver pathology occurring in patients with sickle cell disease is commonly related to viral hepatitis or hepatic iron deposition due to repeated transfusions; cholestasis and cirrhosis may also occur. Consequently, the differential diagnosis of abnormal liver tests in patients with sickle cell anemia is often complicated. We report the case of a patient presenting with jaundice and abnormal liver biochemistries, without typical evidence of the liver diseases associated with sickle cell anemia. Biochemical markers for viral hepatitis were negative. CT scan only showed hepatomegaly. The liver biopsy revealed marked sinusoidal congestion with red blood cells without significant steatosis or increased iron deposition. The patient's medical history corroborated with biochemical tests and histological examination of the liver suggested that worsening hemolysis related to increased sickling of erythrocytes intrahepatically led to sinusoidal dilatation and probably caused the abnormal liver tests.     

The clinical significance of slightly to moderately increased liver transaminase values in asymptomatic patients

BACKGROUND: Our aim was to study liver disorders in asymptomatic patients with slightly to moderately increased liver transaminase values in a population living in an area with a low prevalence of viral and hereditary liver diseases. METHODS: One hundred and fifty consecutive patients with slightly to moderately increased liver transaminases for at least 6 months without symptoms or signs of liver disease were included. Median (range) was 0.75 microkat/l (0.24-2.9) for aspartate aminotransferase (ASAT) and 1.18 microkat/l (0.28-4.5) for alanine aminotransferase (ALAT). A percutaneous liver biopsy was performed, and blood was sampled for a detailed biochemical and serologic profile. RESULTS: Chronic viral hepatitis C was found in 15.3% of the patients, autoimmune hepatitis in 1.3%, primary biliary cirrhosis in 1.3%, and heterozygotic alpha-1-antitrypsin deficiency in 0.7%. Presumed alcoholic liver disease was diagnosed in 8%, and non-alcoholic steatohepatitis in 2%. Chronic hepatitis with no obvious etiology was diagnosed in 24%, of whom 39% had interface hepatitis (piecemeal activity). Seventy-one per cent of these 39% had measurable levels of autoantibodies, but IgG levels within normal limits prevented the 'clinical' diagnosis of autoimmune hepatitis. Liver steatosis was the diagnosis in 40%. Most were overweight and had increased serum triglyceride levels. However, in 13.3% the fatty infiltration was considered 'essential', as both body mass index (BMI) and triglyceride levels were normal. Other diagnoses were liver fibrosis with no obvious inflammatory activity (3.3%), cirrhosis of unknown etiology (0.7%), and for the remaining (3.3%) patients histopathologic findings were considered 'normal'. Cirrhosis was found in five biopsy specimens: hepatitis C (n = 2), autoimmune hepatitis (n = 1), primary biliary cirrhosis (n = 1), and cryptogenic cirrhosis (n = 1). No concomitant disease was of importance for the diagnosis and/or histopathologic findings. No obvious drug-related increased liver test results were found with any single drug. However, patients with chronic hepatitis of unknown etiology, especially with interface hepatitis, significantly more often than the rest of the population were receiving drug treatment. CONCLUSION: Most transaminitis patients had steatosis, and some had defined diseases including chronic hepatitis C. Chronic hepatitis of unknown etiology was found in a substantial proportion (24%) of a population living in an area with a low burden of hepatic viruses and genetic disorders.     

肝活检对82例肝病诊断的临床价值

本文对82例肝病患者做肝活检，并以病理诊断与临床诊断进行对比。结果临床与病理诊断符合者49例，占59．8％，不符合33例占40．2％，其中肝硬化患者临床与病理诊断符合率69．7％，慢性活动性肝炎诊断符合率60％，慢性迁延性肝炎符合率66．7％，肝脓疡及亚急性重症肝炎符合率50％。慢性无症状乙肝病毒携带者8例，病理确诊为慢性迁延性肝炎5例，慢性活动性肝炎1例，肝轻微病变2例。以上资料表明，对肝病患者做肝活检是非常必要的，既可明确诊断，又可早期预防和治疗。     

Clinical significance of elevated alanine aminotransferase in blood donors: a follow-up study.

Alanine aminotransferase (ALT) elevation in blood donors can be related to many variables such as viral hepatitis, overweight and ethanol consumption. BACKGROUND/AIMS: This study aims to define factors associated with ALT elevation in candidates for blood donation, to evaluate ALT levels during follow-up, and to establish a histological diagnosis of hepatic disease. METHODS: Alcoholism, obesity, drug-induced liver disease, diabetes, hemochromatosis and alpha 1-anti-trypsin deficiency were investigated in 119 subjects (113 males, six females, aged 33.4+/-8.4 years) who were hepatitis B surface antigen/anti-hepatitis C virus negative and had been rejected as blood donors as a result of elevated ALT (>1.5 times the upper normal limit (UNL) in two determinations). During follow-up, ALT was determined every 8 weeks and liver biopsy recommended in cases with persistently elevated ALT levels. RESULTS: Obesity (30.2%) and alcoholism (28.6%) were most frequently associated with ALT elevation and in 9.2% of cases no association was found. ALT levels decreased significantly, regardless of the associated factor. Liver histology in 40 patients showed steatosis (35%), steatohepatitis (30%), non-specific reactive hepatitis (12.5% of cases), normal liver (15% of cases) and alcoholic cirrhosis, hemochromatosis and non-specific portal fibrosis in three cases. CONCLUSION: ALT levels usually dropped during follow-up and although severe hepatic lesions can be found in asymptomatic blood donors, mild hepatic damage is the rule.     

e抗原阴性慢性乙型肝炎合并非酒精性脂肪性肝病的病理特征

目的观察HBeAg阴性慢性乙型肝炎合并非酒精性脂肪性肝病患者肝组织病理特征。方法收集72例慢性乙型肝炎合并非酒精性脂肪性肝病患者的肝组织标本及临床相关资料,肝组织标本常规行HE、Masson三色及网状纤维染色,观察其病理改变特点,并进行分级、分期。结果HBeAg阴性慢性乙型肝炎合并非酒精性脂肪性肝病患者肝活检病理学改变以肝细胞脂肪变性为主,肝细胞脂肪变性主要位于腺泡Ⅲ带,呈弥漫分布,重度患者则可扩大至腺泡Ⅱ带甚至全腺泡,轻度患者汇管区炎及界面性炎均不明显,主要为小叶内点灶状坏死,大部分患者仅为血窦壁及中央静脉管壁及周围纤维组织增生,且多为纤细的网状纤维,汇管区纤维组织增生不明显,重度及肝硬化患者则汇管区纤维组织增生显著,彼此相连,破坏正常的肝小叶结构,形成假小叶。结论HBeAg阴性慢性乙型肝炎合并非酒精性脂肪性肝病患者肝组织病理改变具有一定病理学特征;其病理学特征应从炎症、纤维化程度与肝细胞脂肪变性范围、肝细胞损伤等方面综合分析,肝组织活检有助于早期明确诊断,从而指导临床合理治疗。     

Transfusion-transmitted virus in association with hepatitis A-E viral infections in various forms of liver diseases in India

AIM: To describe the prevalence of transfusion-transmitted virus (TTV) infection in association with hepatitis A-E viral infections in different forms of liver diseases in North India. METHODS: Sera from a total number of 137 patients, including 37 patients with acute viral hepatitis (AVH), 37 patients with chronic viral hepatitis (CVH), 31 patients with cirrhosis of liver and 32 patients with fulminant hepatic failure (FHF), were analyzed both for TTV-DNA and hepatitis A-E viral markers. Presence of hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis E virus (HEV) infections was detected in different proportions in different groups. Moreover, TTV-DNA was simultaneously tested in 100 healthy blood donors also. RESULTS: None of the patients had hepatitis A virus (HAV) and hepatitis D virus (HDV) infections. Overall prevalence of TTV-DNA was detected in 27.1% cases with AVH, 18.9% cases with CVH, 48.4% cases with cirrhosis and 9.4% cases with FHF. TTV-DNA simultaneously tested in 100 healthy blood donors showed 27% positivity. On establishing a relation between TTV infection with other hepatitis viral infections, TTV demonstrated co-infection with HBV, HCV and HEV in these disease groups. Correlation of TTV with ALT level in sera did not demonstrate high ALT level in TTV-infected patients, suggesting that TTV does not cause severe liver damage. CONCLUSION: TTV infection is prevalent both in patients and healthy individuals in India. However, it does not have any significant correlation with other hepatitis viral infections, nor does it produce an evidence of severe liver damage in patients with liver diseases.     

Diagnostic value of fibrolaparoscopy and direct-vision peritoneal biopsy in atypical tuberculous peritonitis]

Fifty-three cases of atypical tuberculous peritonitis were diagnosed by Machida FLA-8 fibrolaparoscope and direct-vision peritoneal biopsy in our hospital during the last few years. The misdiagnosis rate of this disease is very high. The rate of accurate clinical diagnosis was only 39.6% in patients of this study, while 60.4% was misdiagnosed as other diseases, such as cirrhosis, chronic hepatitis, hepatic carcinoma ovarian cyst etc. In addition, many patients with other diseases were misdiagnosed as tuberculous peritonitis by clinical consideration, for instance, 56 cases who were diagnosed or doubted as tuberculous peritonitis by clinical consideration were diagnosed as other diseases by laparoscopy and liver and peritoneal biopsy under direct-vision. Among them chronic hepatitis accounted for 32 cases, peritoneal carcinoma 11 cases, cirrhosis 7 cases, normal peritoneum, liver, gall bladder and spleen 6 cases. Therefore, the patient who is presumptively diagnosed as tuberculous peritonitis by clinical consideration should have laparoscopy and direct-vision peritoneal biopsy performed.     

瞬时弹性成像技术在慢性乙型肝炎中的应用进展

肝活检是诊断肝脏疾病的金标准,胃镜是诊断食管胃静脉曲张的金标准;但二者均为有创检查,因此应用受限。近年来瞬时弹性成像技术作为无创检测,临床已经广泛采用。介绍了瞬时弹性成像技术在慢性乙型肝炎患者肝纤维化、肝脂肪变、肝硬化及肝癌等方面的最新进展。未来可在乙型肝炎肝硬化和肝癌早期联合诊疗方面进行更多研究。     

Investigation of alcoholic liver disease

In heavy drinkers with clinical evidence of liver disease, routine investigations should exclude the possibility of other chronic liver diseases of non-alcoholic aetiology requiring specific therapy-these include chronic viral hepatitis, autoimmune diseases of the liver, Wilson's disease and genetic haemochromatosis. If abnormalities in liver biochemistry persist despite abstinence, or if the diagnosis of alcoholic liver disease is in doubt, a liver biopsy should be carried out. Studies evaluating the role of liver biopsy in alcoholic liver disease suggest that without histological confirmation the diagnosis will be inaccurate in 10–20% of patients.Serum biochemistry and the currently available imaging modalities have severe limitations in determining the relative contributions of fatty liver, alcoholic hepatitis and cirrhosis to the overall picture in alcoholic liver disease. Histological examination is therefore of additional value in determining the prognosis, which is worst in patients with a combination of alcoholic hepatitis and cirrhosis.There area number of indices available, based on clinical and laboratory information, for evaluating the short-term prognosis, but these can only be used with accuracy if the histological pattern of damage has initially been evaluated.