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非酒精性脂肪性肝病儿童肝组织病理特征分析

刘敏 陈卫坚 周峥珍 覃小梅 文容 姜楠 匡林芝 郑台青 张丽琼 李双杰

引用本文:
Citation:

非酒精性脂肪性肝病儿童肝组织病理特征分析

DOI: 10.3969/j.issn.1001-5256.2023.05.021
基金项目: 

湖南省卫生健康委科研项目计划 (202206014267)

伦理学声明:本研究方案于2022年8月30日经由湖南省儿童医院医学伦理委员会审批,批号:HCHLL-2020-52。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:刘敏负责收集、分析数据和论文撰写;陈卫坚、周峥珍、覃小梅、文容、姜楠对文章的知识性内容进行补充;匡林芝、郑台青、张丽琼负责实验操作;李双杰负责课题设计、指导论文撰写。
详细信息
    通信作者:

    李双杰,2273858951@qq.com (ORCID: 0000-0002-3792-6793)

Histopathological characteristics of the liver in children with non-alcoholic fatty liver disease

Research funding: 

Research Project Plan of Hunan Provincial Health Commission (202206014267)

More Information
  • 图  1  1区交界型NASH(HE染色,×20)

    注:以门静脉区为中心的腺泡1区(P)周边见大量肝细胞脂肪变性,而腺泡3区(V)不明显。

    Figure  1.  Borderline zone 1 NASH(HE staining, ×20)

    图  2  3区交界型NASH(HE染色,×20)

    注:腺泡3区(V)周边见大量肝细胞脂肪变性,而腺泡1区(P) 无脂肪变性。

    Figure  2.  Borderline zone 3 NASH(HE staining, ×20)

    图  3  桥接纤维化及肝硬化

    注:a, 桥接纤维化,附近两个门静脉区发出的纤维间隔已连接(Masson染色,×20); b, 肝硬化,附近两个门静脉区发出的纤维间隔分割包饶肝细胞,形成假小叶(HE染色,×20)。

    Figure  3.  Bridging fibrosis and cirrhosis

    图  4  不同程度NAS评分图(HE染色,×20)

    注:a, 2分,脂肪变性(1分),小叶炎症(1分),气球样变(0分);b, 5分,脂肪变性(2分),小叶炎症(1分),气球样变(2分);c, 7分,脂肪变性(3分),小叶炎症(2分),气球样变(2分)。

    Figure  4.  NAS of different degrees(HE staining, ×20)

    表  1  87例NAFLD病例临床特点分析

    Table  1.   Clinical characteristics analysis of 87 NAFLD cases

    项目 数值
    年龄(岁) 11.0(10.0~12.3)
    男性[例(%)] 83(95.4)
    女性[例(%)] 4(4.6)
    代谢综合征[例(%)] 44(50.6)
    中心性肥胖[例(%)] 85(97.7)
    2型糖尿病[例(%)] 4(4.6)
    高血压[例(%)] 4(4.6)
    高TG血症[例(%)] 55(63.2)
    低HDL-C血症[例(%)] 39(44.8)
    高non-HDL-C血症[例(%)] 23(26.4)
    胰岛素抵抗[例(%)] 69(79.3)
    高尿酸血症[例(%)] 66(75.9)
    下载: 导出CSV

    表  2  87例NAFLD病例实验室数据

    Table  2.   Laboratory data of 87 NAFLD cases

    项目 数值
    WBC(×109/L) 7.93±1.98
    PLT(×109/L) 321.95±77.20
    Hb(g/L) 136.37±10.64
    ALT(IU/L) 166.95±113.92
    AST(IU/L) 83.82±61.98
    GGT(IU/L) 66.09±83.22
    ALP(U/L) 150.52±4.83
    UA(μmol/L) 426.15±101.36
    TG(mmol/L) 1.92±1.12
    TC(mmol/L) 4.20±0.96
    HDL-C(mmol/L) 1.05±0.26
    non-HDL-C(mmol/L) 3.11±0.92
    FBG(mmol/L) 5.09±1.52
    注:UA,尿酸;FBG,空腹血糖。
    下载: 导出CSV

    表  3  87例NAFLD病例病理特点分布情况

    Table  3.   Distribution of pathological characteristics of 87 NAFLD cases

    项目 例数(%)
    脂肪变性
      1分(5%~33%) 14(16.1)
      2分(34%~66%) 10(11.5)
      3分(>66%) 63(72.4)
    小叶炎症
      1分(<2个炎症坏死灶) 29(33.3)
      2分(2~4个炎症坏死灶) 55(63.2)
      3分(>4个炎症坏死灶) 3(3.4)
    气球样变性
      0分(无) 1(1.1)
      1分(少见) 12(13.8)
      2分(多见) 74(85.1)
    门静脉区炎症
      0分(无) 1(1.1)
      1分(轻度) 66(75.9)
      2分(中度) 18(20.7)
      3分(重度) 2(2.3)
    门静脉区纤维化
      无 10(11.5)
      有 77(88.5)
    纤维化分级
      F0(无纤维化) 10(11.5)
      F1(3区窦周/门静脉周围) 42(48.3)
      F2(窦周和门静脉/门静脉周围) 19(21.8)
      F3(桥接纤维化) 14(16.1)
      F4(肝硬化) 2(2.3)
    NAS评分情况
      0~2分 1(1.1)
      3~4分 10(11.5)
      5~8分 76(87.4)
    NAFLD模式
      非NASH 6(6.9)
      1区交界型 13(14.9)
      3区交界型 6(6.9)
      确定NASH 62(71.3)
    下载: 导出CSV

    表  4  FIB-4对NAFLD肝纤维化、显著肝纤维化、进展期肝纤维化的诊断价值

    Table  4.   Diagnostic value of FIB-4 in NAFLD fibrosis, significant fibrosis and advanced fibrosis

    纤维化阶段 AUC 95%CI 最佳临界值 P 灵敏度(%) 特异度(%) 阴性预测值(%) 阳性预测值(%) 阴性似然比 阳性似然比
    ≥F1 0.636 0.410~0.863 0.16 0.147 79.2 60.0 23.8 92.4 0.35 1.98
    ≥F2 0.654 0.538~0.770 0.23 0.015 51.4 75.0 69.6 58.1 0.31 2.06
    ≥F3 0.618 0.462~0.774 0.27 0.154 40.0 80.6 86.4 28.6 0.74 2.06
    下载: 导出CSV
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