Özet:

Background and Aims: Nonalcoholic steatohepatitis is the progressive form of nonalcoholic fatty liver disease and can cause cirrhosis and hepatocellular carcinoma. We aimed to investigate the changes in liver histology and determined the relationship between histologic progression and clinical and laboratory parameters in patients with nonalcoholic fatty liver disease. Materials and Methods: We retrospectively screened 783 patients with nonalcoholic fatty liver disease who had enrolled in the hepatology database between 1994 and 2009. Among the 783, there were 29 patients with two liver biopsies performed at least two years apart. Body mass index, presence of glucose intolerance or diabetes, and biochemical parameters including liver function test were noted. Nonalcoholic fatty liver disease activity score was the sum of steatosis, lobular inflammation, and hepatocellular ballooning scores. The fibrosis scores were reported separately. Results: Mean patient age was 45.2±11years, and 17 (58.6%) patients were men. Mean body mass index was 29±4 kg/m2, and 15 (51.7%) patients were overweight and 12 (41.4%) were obese. Twelve (41.4%) patients had diabetes mellitus and five (17.2%) patients had glucose intolerance. Mean aspartate aminotransferase level was 51±36 IU/ml, mean alanine aminotransferase level was 79±50 IU/ml, mean albumin level was 4.5±0.4 g/dL, and mean triglyceride level was 197±106 mg/dL at baseline. Fourteen (48.3%) patients had nonalcoholic steatohepatitis and six (20.6%) patients had simple steatosis. The patients followed the recommended exercises and diet for therapy, and control liver biopsies were performed. The median follow-up duration was 4.8 years (2–9). Mean body mass index was 29.6±4 kg/m2, mean aspartate aminotransferase level was 38.8±14 IU/ml, and mean alanine aminotransferase was 59.2±32 IU/ml. Thirteen (44.8%) patients had diabetes mellitus and seven (24.1%) had glucose intolerance at the time when their control biopsies were collected. According to nonalcoholic fatty liver disease activity score, nonalcoholic steatohepatitis progression was detected in 9 (31%) patients, while improvement was detected in 17 (58.6%) patients. In control liver biopsies, nonalcoholic fatty liver disease activity score remained the same in three (10.3%) patients. Six (20.1%) patients experienced progression and three (10.3%) patients showed improvement in fibrosis scores in the control biopsies. Regarding the basal parameters, age was negatively correlated and body mass index was positively correlated with the nonalcoholic steatohepatitis progression (r=−0.370, p=0.047 and r=0.485, p=0.007, respectively). The progression of fibrosis scores was negatively correlated with baseline age and positively correlated with baseline body mass index and aspartate aminotransferase levels when control biopsies were taken (r=−0.503, p=0.005; r=0.382, p=0.04; and r=0.546, p=0.007, respectively). Conclusion: Simple steatosis may progress to nonalcoholic steatohepatitis in patients with younger age and high body mass index. Patients with younger age and higher body mass index at baseline and higher aspartate aminotransferase at the time of collecting the control biopsies were more likely to experience progression of liver fibrosis.

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