老年男性2型糖尿病患者非酒精性脂肪性肝病临床病理研究  

Study on clinico-histopathological changes of non-alcoholic fatty liver disease in elderly male patients with type 2 diabetes mellitus

作　　者：王征[1] 周迎生[2] 何清华[2] 庞建新[1] 杨丽[1] 于启[1] 刘冬戈[1] 

机构地区：[1]卫生部北京医院病理科,100730 [2]卫生部北京医院内分泌科,100730

出　　处：《中华老年医学杂志》2010年第6期506-509,共4页Chinese Journal of Geriatrics

摘　　要：目的 研究老年男性2型糖尿病患者（T2DM）非酒精性脂肪性肝病（NAFLD）发生率及肝脏病理组织学改变的特点.方法 从858例成人尸检材料中,选择病程在10年以上T2DM患者89例为T2DM组,对照组48例,观察各组肝脏组织病理学改变,同时进行组织化学（Masson三色、过碘酸雪夫染色、唾液酶消化-过碘酸雪夫染色、Van Greson氏染色、网状纤维染色）及免疫组织化学（CK8/18）染色.结果 T2DM组89中符合NAFLD诊断44例（49.4%/）,非酒精性脂肪性肝炎（NASH）13例（14.6%）,对照组48例诊断NAFLD为11例（22.9%）,NASH 2例（4.2%）,两组间比较差异有统计学意义（P＜0.01、P＜0.05）.T2DM组诊断NASH患者均伴有肝纤维化,对照组2例中有1例伴有肝纤维化.T2DM组1例出现肝硬化,对照组未见肝硬化病例.结论 与非糖尿病组相比,老年男性T2DM组NAFLD疾病发生率高,肝损伤程度重;T2DM组NASH患者肝纤维化发生率高;NAFLD患者进展为肝硬化比率低.Objective To observe the incidence rate of non-alcoholic fatty liver disease （NAFLD） in elderly male patients with type 2 diabetes mellitus （T2DM） and the features of pathological changes of liver. Methods The 89 cases with T2DM （T2DM group） and contemporary non-diabetic cases （control group, n=48） from 858 autopsy samples matched for gender and age were selected in the study. The histopathological changes of liver were observed by microscopy,histochemistry and immunohistochemistry. Results The incidence rates of NAFLD and nonalcoholic steatohepatitis（NASH） were 49.4% （44/89） and 14.6% （13/89） in T2DM group, 22.9 %（11/48） and 4.2% （2/48） in control group, respectively. The incidence rates of NAFLD and NASH were significantly higher in T2DM group than in control group（P＜0.01, P＜0.05）. All of the NASH patients from T2DM group and one patient from control group were complicated with different stages of liver fibrosis. One patient from T2DM group was diagnosed as cirrhosis, no cirrhosis patient was found in control group. Conclusions Compared with control group, the incidence rate of NAFLD is higher and the damage of liver is more severe in T2DM group. The ratio of the progress from NAFLD to liver cirrhosis is low.

关 键 词：糖尿病 2型 脂肪肝 肝硬化 尸体解剖 

分 类 号：R587.1[医药卫生—内分泌] R575.5[医药卫生—内科学]