RESUMO
UNLABELLED: The non-alcoholic steato-hepatitis (NASH) is a common disorder in obese, type 2 diabetics, female and patients with dislipidaemia. Hepatic biochemical test are abnormal. Despite the lack of its own morphological characteristics, NASH can be differentiated from other pathologies, the gold standard for diagnosis is liver biopsy. MATERIAL AND METHODS: We designed a retrolective, comparative, observational and cross-sectional study. Thirty-five obese subjects (11 men and 24 women) who underwent to bariatric surgery and liuer biopsy were included. Data were taken from clinical files, such as anthropometric and biochemical test. Those who had clinical history of related alcohol ingestion or liver damage related to drugs were excluded. A experimented pathologist classified the biopsies according to Brunt classification. Liver slides were classified according to 1) presence of NASH; 2) Inflammation and 3) Fibrosis. Differences between groups were analysed by ANOVA and Spearman correlation. RESULTS: We found differences between women (w) and men (m) for height (m: 1.71 +/- 0.9 vs. w:1.60 +/- 0.09m); weight (m:172.5 +/- 39.1 vs. w:126.9 +/- 24.1kg) and BMI (m:58.2 +/- 9.8 vs. w:49.8 +/- 9) , but not for NASH frequency. Nevertheless subjects with NASH (n = 29, 82.8%o) were older than those without NASH (38.3 +/- 9.6 vs. 29.5 +/- 5.2) and had higher aminotrasferases serum levels (AST: 33.1 +/- 19.2 vs. 23.7 +/- 6.3 ULIL; ALT: 36.5 +/- 19.8 vs. 20.3 +/- 7.6ULIL). NASH pa- tients and those with higher grade of histological inflammation had increment of transaminases and albumin levels. Fibrosis showed correlation only with AST (p = 0.020) and ALT (p = 0.002). CONCLUSION: The NASH frequency in patients who underwent to bariatric surgery for weight reduction is very high (82.8%) and exists correlation among liver test and histological findings but not with clinical because the clinical diagnosis is complicated.
Assuntos
Fígado Gorduroso/diagnóstico , Testes de Função Hepática , Obesidade Mórbida/complicações , Adulto , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Cirurgia Bariátrica , Biópsia , Estatura , Índice de Massa Corporal , Estudos Transversais , Ácidos Graxos/sangue , Fígado Gorduroso/sangue , Fígado Gorduroso/etiologia , Fígado Gorduroso/patologia , Feminino , Hepatite/etiologia , Hepatite/patologia , Humanos , Resistência à Insulina , Cirrose Hepática/etiologia , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Prevalência , Estudos RetrospectivosRESUMO
The non-alcoholic steato-hepatitis (NASH) is a common disorder in obese, type 2 diabetics, female and patients with dislipidaemia. Hepatic biochemical test are abnormal. Despite the lack of its own morphological characteristics, NASH can be differentiated from other pathologies, the gold standard for diagnosis is liver biopsy. Material and methods: We designed a retrolective, comparative, observational and cross-sectional study. Thirty-five obese subjects (11 men and 24 women) who underwent to bariatric surgery and liver biopsy were included. Data were taken from clinical files, such as anthropometric and biochemical test. Those who had clinical history of related alcohol ingestión or liver damage related to drugs were excluded. A experimented pathologist classified the biopsies according to Brunt classification. Liver slides were classified according to 1) presence of NASH; 2) Inflammation and 3) Fibrosis. Differences between groups were analysed by ANOVA and Spearman correlation. Results: We found differences between women (w) and men (m) for height (m: 1.71 ± 0.9 vs. w:1.60 ± 0.09m); weight (m: 172.5 ± 39.1 vs. w: 126.9 ± 24.1kg) and BMI (m:58.2 ± 9.8 vs. w:49.8 ± 9) , but not for NASH frequency. Nevertheless subjects with NASH (n = 29, 82.8%) were older than those without NASH (38.3 ± 9.6 vs. 29.5 ± 5.2) and had higher aminotrasferases serum levels (AST: 33.1 ± 19.2 vs. 23.7 ± 6.3 UL/L; ALT: 36.5 ± 19.8 vs. 20.3 ± 7.6UL/L). NASH patíents and those with higher grade of histological inflammation had increment of transaminases and albumin levels. Fibrosis showed correlation only with AST (p = 0.020) and ALT (p = 0.002). Conclusion.The NASH frequency in patients who underwent to bariatric surgery for weight reduction is very high (82.8%) and exists correlation among liver test and histological findings but not with clinical because the clinical diagnosis is complicated.
La esteatohepatitis no alcohólica (EHNA) es una alteración hepática frecuente en obesos, diabéticos tipo 2, mujeres y personas con dislipidemia. Clínicamente se acompaña de alteraciones en las pruebas de función hepática (PFH), y aunque carece de características morfológicas distintivas, puede ser razonablemente diferenciada de otras entidades, el método diagnóstico por excelencia es la biopsia hepática. Material y métodos. Se diseñó un estudio retrolectivo, comparativo, observacional y transversal en el que se incluyeron 35 pacientes obesos (11 hombres y 24 mujeres) sometidos a tratamiento quirárgico para reducción de peso, con biopsia hepática en el periodo transoperatorio. Se obtuvieron, del expediente clínico, datos antropométricos y de laboratorio. Se excluyeron los pacientes con antecedentes de ingestión de alcohol y medicamentos asociados a la presencia de EHNA. Se recabaron muestras de las biopsias hepáticas que fueron analizadas por un patólogo experimentado, empleando la clasificación de Brunt para estratificación de EHNA. Los datos se clasificaron de acuerdo con: 1) Presencia de EHNA, 2) Grado de inflamación, 3) Presencia de fibrosis. Las diferencias entre los grupos fueron analizadas con Krusskal Wallis y correlación de Spearman. Resultados. Se encontró diferencias entre hombres (H) y mujeres (M) en estatura: (H:1.71 ± 0.9. vs. M:1.60 ±0.09 m); peso (H: 172.5 ± 39.1 vs. M:126.9 ± 24.1 kg) e índice de masa corporal (H:58.2 ± 9.8 vs. M: 49.8 ± 9); no hubo diferencias en la frecuencia de EHNA por género. Los sujetos con diagnóstico morfológico de EHNA (n = 29, 82.8%) mostraron una edad promedio mayor que el grupo sin EHNA (38.3 ± 9.6 vs. 29.5 ± 5.2, respectivamente) del mismo modo, la concentración de transaminasas fue mayor para el grupo con EHNA (AST: 33.1 ± 19.2 vs. 23.7 ± 6.3 UL/ L; ALT: 36.5 ± 19.8 vs. 20.3 ± 7.6 UL/L). Los pacientes con EHNA y con mayor grado de inflamación histológica mostraron mayor elevación de transaminasas y albámina. La presencia de fibrosis correlacionó con la elevación de aspartato aminotransferasa (AST p = 0.020) y alanino aminotransferasa (ALT p = 0.002). Conclusión. Este estudio demuestra que la frecuencia de EHNA en pacientes obesos sometidos a cirugía para reducción de peso en la clínica de obesidad del Instituto es alta (82.8%) y que existe una buena correlación entre las pruebas de función hepática y las alteraciones morfológicas; sin embargo, las anteriores no correlacionan con las manifestaciones clínicas por lo que el diagnóstico clínico temprano es difícil.