基于NASH-CRN方案的130例非酒精性脂肪性肝病病理研究  

Pathological study of 130 cases of nonalcoholic fatty liver disease based on NASH-CRN system

作　　者：周光德[1] 赵景民[2] 丁效蕙[2] 潘登[2] 孙艳玲[2] 杨建法[2] 赵雨来[2] 

机构地区：[1]军事医学科学院放射医学研究所,北京100850 [2]解放军第302医院病理科

出　　处：《解放军医学杂志》2007年第2期96-99,共4页Medical Journal of Chinese People's Liberation Army

摘　　要：目的参照2005年NASH临床研究网络病理学会(NASH-CRN)评估方案,研究非酒精性脂肪性肝病(NAFLD)的病理特点。方法对130例NAFLD的肝穿组织进行常规HE、网状纤维和Masson三色染色,观察分析NAFLD的病理改变。采用免疫组织化学染色排除其他非NAFLD肝病。结果脂肪变性、肝细胞气球样变、小叶内炎症和纤维化发生普遍,脂肪变性以大泡型为主,肝腺泡3带为著,肝细胞气球样变发生率为94.6%,小叶内炎症多为轻度炎症。统计学分析示,脂肪变性与小叶内炎症、纤维化、肝细胞气球样变程度间呈正相关(r值分别为0.587、0.374、0.488,P均<0.01)。随脂肪变性、小叶内炎症、纤维化程度的加重,微肉芽肿、脂性肉芽肿和凋亡小体出现频率呈增加趋势。随气球样变程度加重,巨大线粒体和糖原核发生率明显增高(P均<0.01)。结论在NAFLD的评估中,除脂肪变性、肝细胞气球样变、小叶内炎症和纤维化外,汇管区炎症也应予以重视。微肉芽肿、脂性肉芽肿和凋亡小体是否可作为NAFLD病情进展的组织学指标尚需进一步验证。Objective To summarize the pathological features of nonalcoholic fatty liver disease （NAFLD） in China based on a histological scoring system for NAFLD designed by the Pathology Committee of NASH Clinical Research Network （NASH-CRN）. Methods The specimens of liver needle biopsy from 130 patients with NAFLD were examined with light microscopy after haernatoxylin eosin, reticular fiber, and Masson triehrome staining. Immunohistoehemistry staining of the sections, combined with clinical data, was used to exclude non-NAFLD eases. Results Hepatic steatosis, lobular inflammation, hepatoeyte ballooning and fibrosis existed extensively in 130 cases NAFLD liver tissues. Furthermore, maerovesieular steatosis predominantly located in aeinar zone 3 was the main pathological feature of NAFLD, and lobular inflammation was usually mild. Hepatoeyte ballooning was observed in 94. 6 percent of 130 cases. Mild perisinusoidal fibrosis and periportal fibrosis were often observed in stage 1. According to the statistic analysis, hepatic steatosis was positively correlated with lobular inflammation, hepatoeyte ballooning and fibrosis （r=0. 587, 0. 488, 0. 374, respectively; all P value 〈0. 01）. The number of microgranulomas, lipogranulomas and apoptotie bodies increased parallel with increasing severity of steatosis, lobular inflammation and fibrosis. Meanwhile, the number of megamitoehondria and glycogen nuclei was parallel with the degree of hepatoeyte ballooning （all P value 〈0. 01）. Conclusion The role of portal inflammation should be emphasized besides hepatic steatosis, lobular inflammation, hepatoeyte ballooning and fibrosis in the diagnosis and evaluation of NAFLD. It needs to further verify that if microgranulomas, lipogranulornas and apoptosis bodies could be used as histopathologieal markers of development of NAFLD.

关 键 词：非酒精性脂肪性肝病 病理 NASH-CRN方案 

分 类 号：R361.2[医药卫生—病理学]