Portal Chronic Inflammation in Nonalcoholic Fatty Liver Disease: An Histologic Marker of Advanced NAFLD Clinicopathologic Correlations from the NASH Clinical Research Network
| Autor: | Matthew M. Yeh, Patricia Belt, Linda D. Ferrell, Monique Rosenthal, Wana Kim, Manual Celedon, Kevin Edwards, Yao Chang Liu, Naga Chalasani, Jay E. Everhart, Rosemary Hollick, Nathan M. Bass, Linda Ragozzino, Jody Mooney, Aynur Unalp-Arida, Milana Isaacson, Melissa Smith, Denise Espinosa, Katherine P. Yates, Alison Lyndecker, Kavita Nair, James E. Nelson, Arun J. Sanyal, Aynur Unalp, Joan Siegner, Susana Mendoza, Diane Bringman, Kiran Bambha, Dawn Piercy, Margaret Stager, Melissa J. Contos, Claude B. Sirlin, Grace Gyurkey, Alice L. Sternberg, Ann O. Scheimann, Cynthia Behling, Jeffrey B. Schwimmer, Parvathi Mohan, Cynthia E. Behling, Ryan Colvin, Ann Klipsch, Sarah E. Barlow, Oscar W. Cummings, Ruth Sargent, Lydia Lee, Laura A. Wilson, Amy Jones, Marcia R. Gottfried, Anna Mae Diehl, Laura Miriel, Brent A. Neuschwander-Tetri, Michael Torbenson, David E. Kleiner, Manal F. Abdelmalek, Barbara Calabrese, Mika Green, Michel Donithan, Martin F. Graham, Kris V. Kowdley, Raj Vuppalanchi, Leanel Fairly, Elizabeth M. Brunt, Melissa J. Coffey, Arthur J. McCullough, Joyce Hoffmann, Paul G. Killenberg, Allison Tobin, Jose Derdoy, Melissa Young, Mark L. Van Natta, Janis Durelle, Susan Stewart, Prajakta Bhimalli, Cheryl Saunders, Judy Thompson, Michael Fuchs, Sherry Boyett, Daphne Bryan, Melanie B. White, Karen F. Murray, Srinivasan Dasarathy, Gilman D. Grave, Sarah Roberts, Tarek Hassanein, Edward Doo, Velimir A. Luketic, Jeanne M. Clark, Debra King, Fred Brancati, Alice Stead, Terry T.-K. Huang, Mark Pabst, James Tonascia, Tanya Stein, Laura Wilson, Brent A. Tetri, Bimalijit Sandhu, Danuta Filipowski, Kimberly Selph, Tessa Steel, Chia Wang, Yi Ping Pan, Raphael B. Merriman, Carol Hawkins, Debra Peglow, Nicholette Rogers, Joel E. Lavine, Stephanie H. Abrams, Philip J. Rosenthal, Leonard B. Seeff, Jay H. Hoofnagle, Diana Arceo, Girish Subbarao, Patricia R. Robuck, Carol Sargeant, Cynthia D. Guy, Lisa Clark, Jean P. Molleston, D Kleiner, Samantha Kwan |
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| Jazyk: | angličtina |
| Rok vydání: | 2009 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Biopsy Gastroenterology digestive system Article Sex Factors Insulin resistance Internal medicine Diabetes mellitus Nonalcoholic fatty liver disease medicine Humans Child Inflammation Hepatology biology business.industry Liver Diseases Fatty liver Age Factors nutritional and metabolic diseases Alanine Transaminase Middle Aged medicine.disease digestive system diseases Fatty Liver Phenotype Liver Alanine transaminase Chronic Disease Disease Progression biology.protein Female Steatohepatitis Steatosis business |
| Popis: | Adult nonalcoholic fatty liver disease (NAFLD) is characterized by absent or mild portal chronic inflammation (CI); in children, portal CI may be predominant. This study correlated clinical features with portal CI. Centrally-graded biopsies and temporally-related clinical parameters from 728 adults and 205 children. From the Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN) were evaluated. Mild, more than mild and no portal CI were found in 60%, 23% and 16% of adult biopsies and 76%, 14% and 10% of pediatric biopsies. Autoantibodies, and elevated alanine aminotransferase were not associated with portal CI. Clinical features associated with “more than mild” in adults were older age (P < 0.0001), female gender (P = 0.001), higher body mass index (P < 0.0001), elevated insulin levels (P = 0.001), higher homeostasis model assessment of insulin resistance score (HOMA-IR) (P < 0.0001), and medications used for NAFLD (P = 0.0004), diabetes (P < 0.0001), and hypertension (P < 0.0001). “More than mild” in the pediatric biopsies correlated with younger age (P = 0.01), but not with body mass index, insulin or HOMA-IR. In both groups, lobular and portal inflammation scores had no association, but there was an association with definite steatohepatitis (P < 0.0001). Features associated in the adult biopsies with “more than mild” were steatosis amount (P = 0.01) and location (P < 0.0001), ballooning (P < 0.0001), and advanced fibrosis (P < 0.0001). In the pediatric biopsies, “more than mild” was associated with steatosis location (P = 0.0008) and fibrosis score (P < 0.0001), specifically, the portal/periportal fibrosis or greater fibrosis) (P < 0.01). Conclusion: Increased portal CI is associated with many clinical and pathologic features of progressive NAFLD in both adults and children, but not with ALT, autoantibodies, or lobular inflammation. More than mild portal CI in liver biopsies of untreated NAFLD may be considered a marker of advanced disease. (HEPATOLOGY 2009.) |
| Databáze: | OpenAIRE |
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