在在日本的不含酒精的 steatohepatitis 的诊断的当前的地位和议程

• 作者: Masafumi Ono Yoshio Sumida Yuichiro Eguchi
• 来源期刊: 世界肝病学杂志：英文版（电子版）
• 学科: 医学
• 关键词: INSULIN resistance LIVER BIOPSY OXIDATIVE stress FIBROSIS
• 年，卷（期）: 2010,（10）
• 页码范围: 374-383
• 页数: 10页
• 分类号: R575.5

摘要

Nonalcoholic fatty liver disease(NAFLD),a manifestation of metabolic syndrome,includes a wide range of clinical entities from simple fatty liver,a benign condition,to nonalcoholic steatohepatitis(NASH),a condition which can progress to cirrhosis,hepatocellular carcinoma and hepatic failure.The diagnosis of NASH requires no history of previous or current significant alcohol cons umption and no evidence of other chronic liver dis eases.Ethanol intake levels of 20 g daily(or 140 g weekly) are endorsed as the acceptable threshold to define no nalcoholic patients.Liver biopsy is the current gold stan d ard for the diagnosis of NASH and provides progn o stic information.Histopathological diagnosis of NASH is based on the following 3 features:(1) hepatic macrovesicular steatosis;(2) lobular inflammation;and(3) ballooning degeneration of hepatocytes.It is impractical to biopsy every patient with suspected NAFLD.Although highly accurate and affordable noninvasive screening tools can differentiate NASH from NAFLD,no imaging studies or laboratory tests are able to precisely diagnose NASH.There is no universal agreement regarding the indications for liver biopsy in NAFLD patients.In Japan,liver biopsies are considered in patients with sus pected NAFLD based on several criteria including low platel et counts,elevated fibrosis markers,increasing age and other deciding parameters.Further studies are needed to establish a suitable scoring system that can distinguish steatohepatitis from simple steatosis.