The risk factors of fibrosis in nonalcoholic steatohepatitis.
Nonalcoholic steatohepatitis (NASH) can be a severe progressive liver disease leading to the development of cirrhosis. The aim of this study was to assess the risk factors of fibrosis in NASH.


METHODS
The clinical, biochemical and histological features of 80 patients with NASH admitted at University Hospital from 1998 to 2000, were analyzed. The patients had no alcoholic, viral, autoimmune, drug induced or genetic liver disease. The fibrosis and necroinflammatory activity was associated with clinico-biochemical parameters and with oxidative stress. The clinical and biochemical parameters consist of: age, sex, body mass index (BMI), serum glucose, tryglycerides, alanine aminotransferase (ALT) and serum iron study (transferring saturation and ferritin). Liver iron overload was assessed by Pearls'staining and graded in four classes. The oxidative stress was evaluated by the levels of serum malon-dyaldehide (MDA) and serum total gluthatione (GSI4).


RESULTS
Septal fibrosis was present in 30 patients (27%) including cirrhosis in 4 patients (5%). Age > 45 years, B.M.I. >30 Kg/m2, serum tryglycerides >180 mg/dl, hyperglycemia > 220 mg/dl, serum ALT > 3N, increased hepatic iron and transferrin saturation percentage were independently associated with sepal fibrosis. Linear regression analysis showed that increased hepatic iron had the greatest association with the increase of lipid peroxidation (MDA > 250 nanomol/dl) and the decrease of serum gluthatione (< 40 micromol/dl).


CONCLUSIONS
The clinical and biochemical parameters which consist of age, BMI, serum ALT, glucose and tryglycerides, Perls' grade and the serum index of oxidative stress (MDA and GSH) are independent risk factors for fibrosis in NASH raising therapeutic implications for the management of these patients.
Fierbinţeanu-Braticevici
Carmen
C
Medical Clinic II, University Hospital, 169, Splaiul Independenţei, Bucharest, Romania.
Bengus
Andreea
A
Neamţu
Monica
M
Usvat
R
R
D000328:Adult; D000368:Aged; D005234:Fatty Liver / Q000150:complications*; D005260:Female; D006801:Humans; D019190:Iron Overload / Q000150:complications*; D008103:Liver Cirrhosis / Q000209:etiology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012307:Risk Factors