RAMB - Maio / Junho 2016

ndrade

224

ssoc

ras

2016; 62(3):218-226

In the literature it is accepted that the mere presence

of fat without inflammation in the liver may have a be-

nign course, although the association of steatosis, inflam-

mation, ballooning degeneration, Mallory bodies and fi-

brosis characterizes NASH, which can develop into

cirrhosis and resulting complications, such as hepatocar-

cinoma.

The progression from steatosis to cirrhosis and

death due to its complications only occurs in less than

5% of cases; however, when steatohepatitis is present, that

frequency of progression can reach up to 25%.

Data about

the speed of the progression of this disease is scarce.

38 of the 62 patients studied (61%) were classified as

having NASH. Of these 38 patients, 30/62 (48%) were

classified as having probable NASH, that is, abnormal

USG associated with increased transaminases and risk

factors for metabolic syndrome, while 21/62 (34%) had

definitive NASH, that is, with a biopsy proving NASH.

The definitive diagnosis of steatosis was described in

the 22 biopsies performed, with ballooning degeneration

in 73% and fibrosis also in 73% of the biopsies. Grade 4

fibrosis was found in 36% of the biopsies, demonstrating

the presence of cirrhosis in most patients undergoing bi-

opsy and the importance of carrying out a biopsy in pa-

tients being investigated for NAFLD, not only for diag-

nosis, but also to assess the progression of the disease. In

all patients that showed cirrhosis, we found clinical signs

of chronic liver disease, and in patients with a severe lev-

el of fibrosis, it is suggested that there is greater risk of

progression to hepatocellular carcinoma.

47,49

The findings of ballooning degeneration in 73% of

patients and grade 4 fibrosis in 36% are the only data from

biopsies in this study that were found in greater frequen-

cy than described in the literature, which is around 33

and 6%, respectively. With respect to the presence of fi-

brosis of all grades, iron overload and hepatocellular car-

cinoma were found at a frequency similar to previous

studies. Lastly, the presence of Mallory bodies in 50% and

grade 1 fibrosis in 18% represented values lower than those

described previously, being found in the literature at

around 80 and 27%.

8,23,32

Other findings in the biopsy, such as standard bili-

ary portal reaction and ductal proliferation found in 18

and 14% of the biopsies, respectively, suggest a progres-

sive pattern of the disease.

onclusion

Considering the epidemic of metabolic syndrome in the

modern world, the investigation of other components of

this syndrome is necessary. Metabolic syndrome summa-

rizes a large part of the systemic manifestations of insu-

lin resistance. In addition to the classic components of

the syndrome, new components of great clinical relevance,

such as NAFLD, have been demonstrated.

Current studies indicate a growing frequency of this

disease in association with metabolic syndrome risk fac-

tors, meaning that better diagnostic and prognostic in-

vestigation of NAFLD is required. As there is an impor-

tant association between NAFLD and metabolic syndrome,

this emphasizes a need to control their component fac-

tors and corroborates the idea that NAFLD may be a he-

patic component of metabolic syndrome.

Screening for metabolic syndrome with laboratory

and imaging exams should be supplemented with anthro-

pometric measurements, which are often neglected in the

physical exam.

As an insidious and progressive illness with nonspe-

cific symptoms, NAFLD can have a malignant course, pro-

gressing to NASH, cirrhosis of the liver and hepatocellu-

lar carcinoma. Thus, liver biopsy becomes an indispensable

examination for evaluating the course of the disease.

We documented NAFLD in all of its clinical forms,

predominantly steatohepatitis. The most frequent risk

factors were metabolic syndrome and its variables: in-

creased waist circumference, dyslipidemia and hyperten-

sion. This underscores the importance of metabolic con-

trol in NAFLD and confirms its role as the hepatic

component of metabolic syndrome.

As an insidious and progressive illness with nonspe-

cific symptoms, NAFLD can have a malignant course, pro-

gressing to NASH, cirrhosis of the liver and hepatocellu-

lar carcinoma. Thus, liver biopsy becomes an indispensable

examination for evaluating the course of the disease.

NASH was described in practically a third of the sam-

ple, while hepatocellular carcinoma was described in about

5% of patients. The findings of grade 4 fibrosis in 36% of

the sample, in addition to findings of NASH and hepa-

tocellular carcinoma, are higher than the described in the

literature. This may be explained by the fact that the sam-

ple in the present study includes patients cared for at a

reference center, many of whom are at an advanced stage

of hepatic impairment.

esumo

Doença hepática gordurosa não alcoólica em diferentes

populações: um estudo clínico e epidemiológico – Amos-

tra de São José do Rio Preto

Introdução:

a doença hepática gordurosa não alcoólica

(DHGNA) é uma condição heterogênea que inclui estea-