病态肥胖患者肝脏病变的组织病理学算法和评分系统。

Histopathological algorithm and scoring system for evaluation of liver lesions in morbidly obese patients.

机构信息

Assistance Publique-Hôpitaux de Paris, Beaujon Hospital, Pathology Department, Clichy, France.

出版信息

Hepatology. 2012 Nov;56(5):1751-9. doi: 10.1002/hep.25889.

DOI:10.1002/hep.25889

PMID:22707395

Abstract

UNLABELLED

Nonalcoholic fatty liver disease (NAFLD) is highly prevalent and being overweight is a significant risk factor. The aim was to build an algorithm along with a scoring system for histopathologic classification of liver lesions that covers the entire spectrum of lesions in morbidly obese patients. A cohort of 679 obese patients undergoing liver biopsy at the time of bariatric surgery was studied. An algorithm for segregating lesions into normal liver, NAFLD, or nonalcoholic steatohepatitis (NASH) was built based on semiquantitative evaluation of steatosis, hepatocellular ballooning, and lobular inflammation. For each case, the SAF score was created including the semiquantitative scoring of steatosis (S), activity (A), and fibrosis (F). Based on the algorithm, 230 obese patients (34%) were categorized as NASH, 291 (43%) as NAFLD without NASH, and 158 (23%) as not NAFLD. The activity score (ballooning + lobular inflammation) enabled discriminating NASH because all patients with NASH had A ≥ 2, whereas no patients with A < 2 had NASH. This score was closely correlated with both alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (P < 0.0001, analysis of variance [ANOVA]). Comparison of transaminase levels between patients with normal liver and pure steatosis did not reveal significant differences, thus lending support to the proposal not to include steatosis in the activity score but to report it separately in the SAF score. In the validation series, the interobserver agreement for the diagnosis of NASH was excellent (κ = 0.80) between liver pathologists. There was no discrepancy between the initial diagnosis and the diagnosis proposed using the algorithm.

CONCLUSION

We propose a simple but robust algorithm for categorizing liver lesions in NAFLD patients. Because liver lesions in obese patients may display a continuous spectrum of histologic lesions, we suggest describing liver lesions using the SAF score.

摘要

非酒精性脂肪性肝病（NAFLD）的患病率很高，超重是一个重要的危险因素。本研究旨在建立一种算法和评分系统，用于对病态肥胖患者的肝脏病变进行组织病理学分类，涵盖病变的整个范围。研究了一组 679 名在接受减肥手术时进行肝活检的肥胖患者。基于对脂肪变性、肝细胞气球样变和肝小叶炎症的半定量评估，建立了一种将病变分为正常肝脏、NAFLD 或非酒精性脂肪性肝炎（NASH）的算法。对于每个病例，创建了 SAF 评分，包括脂肪变性（S）、活动度（A）和纤维化（F）的半定量评分。根据该算法，230 名肥胖患者（34%）被归类为 NASH，291 名（43%）为非 NASH 的 NAFLD，158 名（23%）为非 NAFLD。活性评分（气球样变+肝小叶炎症）能够区分 NASH，因为所有 NASH 患者的 A≥2，而 A<2 的患者没有 NASH。该评分与丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）密切相关（P<0.0001，方差分析[ANOVA]）。正常肝脏和单纯脂肪变性患者之间的转氨酶水平比较没有显示出显著差异，因此支持不将脂肪变性纳入活性评分的建议，而是在 SAF 评分中单独报告。在验证系列中，肝脏病理学家之间对 NASH 的诊断具有极好的观察者间一致性（κ=0.80）。初始诊断与使用算法提出的诊断之间没有差异。