Relación entre el diagnóstico morfológico de EHNA (esteatohepatitis no alcohólica) y pruebas de función hepática en un grupo de pacientes con obesidad extrema / Relationship between morphological diagnosis of NASH (Non-Alcoholic SteatoHepatitis) and liver function test in a group of patients with morbid obesity. Cases study

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.

Effect of total flavonoids of Chinese hawthorn leaf on expression of NF-?B and its inhibitor in rat liver with non-alcoholic steato-hepatitis / 中华中医药杂志

Objective:To study the effect of NF-?B and its inhibitor in rats liver during the development of non-alcoholic steato-hepatitis and observe the effect of total flavonoids of Chinese hawthorn leaf on expressions of NF-?B and its inhibitor,and explore the prevention and treatment mechanism of non-alcoholic steato-hepatitis. Methods:Non-alcoholic steato-hepatitis SD rats model were established by administering a high-fat diet for 12 weeks and were treated with total flavonoids of Chinese hawthorn leaf at dosages of 250mg/kg body weight /d,125 mg/kg body weight /d and with Essentiale at a dosage of 195.4mg /kg body weight /d. Pathological changes of liver tissues were observed with HE,the serum MDA,SOD and TNF-? were measured,the protein and mRNA expressions of NF-?B and I?B in rats liver were detected with RT-PCR and immunohistochemical method. Results:There were severe steatosis inflammatory cell infiltration and necrotic foci in non-alcoholic steato-hepatitis rat. Compared with the control group,contents of the serum MDA and TNF-? in non-alcoholic steato-hepatitis group obviously increased,the activity of SOD decreased,the mRNA and protein expressions of NF-?B P65 and I?B? in liver obviously strengthened. There was a positive relativity of the protein expression of NF-?B p65,I?B? with the contents of serum TNF-?,MDA,but a negative relativity with the activity of serum SOD. Conclusion:Total flavonoids of Chinese hawthorn leaf can obviously lower lipid peroxidation in rats,lower the harm of cytokine to hepatocytes,and regulate the expression of protein and mRNA of NF-?B and I?B. It maybe the important mechanism of total flavonoids of Chinese hawthorn leaf for preventing and treating the development of non-alcoholic steato-hepatitis.