Objective: To investigate the clinical and pathologic characteristics of obese adults with nonalcoholic fatty liver disease (NAFLD) and to aid the diagnosis of nonalcoholic steatohepatitis (NASH). Methods: A total of 262 patients eligible for inclusion who received volume reduction metabolism surgery and liver biopsy in the First Affiliated Hospital of Nanjing Medical University from June 2018 to September 2019 were selected. HE staining, reticular fiber staining and Masson staining were performed. Statistical analysis was performed using SPSS 20.0. Results: The patients ranged in age from 18 to 66 years. Among the 262 cases, 65 cases (65/262, 24.8%) were male and 197 cases (197/262, 75.2%) were female. Sixty-one cases (61/262, 23.3%) were non-NAFLD, 201 cases (201/262, 76.7%) were NAFLD including 27 cases (27/201, 13.4%) of nonalcoholic fatty live (NAFL) and 174 cases (174/201, 86.6%) of NASH. The main lesions of NAFLD were in hepatic acinus zone 3. There were significant differences in age, alanine aminotransferase (ALT), glutamic oxaloacetic transaminase (AST), body mass index (BMI), fasting blood-glucose (FPG) and apolipoprotein A (APOA) levels among the non-NAFLD group, NAFL group and NASH group (P<0.05). Patients with BMI≥35 m/kg2 combined with type 2 diabetes had a higher prevalence of NASH. Multiple logistic regression showed that ALT and APOA were independent predictors of NASH (P<0.001, OR=1.05, 95%CI: 1.020-1.082; P=0.027, OR=0.916, 95%CI: 0.878-0.941). Total cholesterol (CHO) and high-density lipoprotein (HDL) were independent predictors of lobular inflammation (P=0.043, 95%CI: 0.010-0.634; P=0.024, 95%CI:-3.068--0.216). AST and HDL were independent predictors of fibrosis stage (P=0.029, 95%CI: 0.001-0.021; P<0.001, 95%CI:-2.670--0.645). Conclusions: Biochemical indicators of NAFLD are closely related to its pathology. The histological lesions of NAFLD are mainly present in hepatic acinar area 3. The diagnosis of NASH is supported by extensive steatosis and high levels of CHO, ALT, AST and BMI, low levels of HDL and ApoA in biochemical markers, but pathological examination is still the gold standard for it.
目的： 探讨我国成人肥胖患者非酒精性脂肪性肝病（nonalcoholic fatty liver disease，NAFLD）的临床病理学特征，为非酒精性脂肪性肝炎（nonalcoholic steatohepatitis，NASH）的诊断提供病理依据。 方法： 选取南京医科大学第一附属医院2018年6月至2019年9月接受减容代谢手术同时进行肝活检且符合纳入条件的病例共262例，行HE染色、网状纤维染色及Masson染色，采用SPSS 20.0进行统计学分析。 结果： 262例患者年龄18~66岁，男性65例（65/262，24.8%），女性197例（197/262，75.2%），其中NAFLD 201例（201/262，76.7%），非NAFLD 61例（61/262，23.3%），NAFLD中包括非酒精性单纯性脂肪肝（nonalcoholic fatty liver，NAFL）27例（27/201，13.4%）、NASH 174例（174/201，86.6%）。NAFLD的病变以肝腺泡3区为主，非NAFLD组、NAFL组与NASH组在年龄、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、体重指数、空腹血糖和载脂蛋白A等水平上差异有统计学意义（P<0.05），体重指数≥35 m/kg2合并2型糖尿病的患者具有较高的NASH患病率。多因素Logistic回归显示丙氨酸氨基转移酶与载脂蛋白A是NASH的独立预测因素（P<0.001，OR=1.05，95%CI为1.020~1.082；P=0.027，OR=0.916，95%CI为0.878~0.941）；总胆固醇与高密度脂蛋白是小叶炎症程度的独立预测因素（P=0.043，95%CI为0.010~0.634；P=0.024，95%CI为-3.068~-0.216）；天冬氨酸氨基转移酶与高密度脂蛋白是纤维化分期的独立预测因素（P=0.029，95%CI为0.001~0.021；P<0.001，95%CI为-2.670~-0.645）。 结论： 生化指标与病理关系密切，NAFLD的组织学病变以肝腺泡3区为主，当脂变广泛、生化指标出现高水平总胆固醇、丙氨酸氨基转移酶、天冬氨酸氨基转移酶和体重指数、低水平高密度脂蛋白和载脂蛋白A时，支持NASH的诊断，但病理学检查仍是诊断NASH的金标准。.