[Fatty hepatosis. Non-alcoholic steatohepatitis (evolution of the knowledge about clinico-morphological features, prognosis, treatment)].
OBJECTIVE
To study histological, clinical features and prognosis in patients with fatty hepatosis (FH) and non-alcoholic steatohepatitis (NASH).


METHODS
Clinical and laboratory data on 74 patients with FH of non-alcoholic origin were studied. All the patients have undergone puncture biopsy of the liver (a total of 91 biopsies). Patients with fatty dystrophy of the first, second and third degree and fibrosis of the first and second degree entered the group of fatty hepatosis without inflammation (group 1, n = 54), patients with fatty dystrophy of the second and third degree and fibrosis of the third degree were assigned to group 2 (n = 20), i.e. to the group of FH with inflammation. The latter group by modern histological characteristics belongs to NASH.


RESULTS
Functional disorders of the liver were insignificant, urobilinogenuria, delayed retention of bromsulphalein, hypertriglyceridemia were observed. AlAT activity was insignificantly elevated in FH patients. It was elevated 1.5-2.5-fold in NASH, the activity of AsAT, gamma-GTP was high in half of the patients. NASH has no specific clinico-biochemical signs and its diagnosis is based on the data of puncture biopsy of the liver. Long-term follow-up of 42 patients with FH and NASH discovered stabilization of the process in 34 patients. Cirrhosis of the liver occurred in 5 patients. Repeated biopsies established association of fatty dystrophy with developing micronodular cirrhosis.


CONCLUSIONS
NASH is an independent disease. This should be taken into consideration in differential diagnosis in patients with a stable rise of serum activity of AlAT and AsAT, especially in obesity, diabetes, hyperlipidemia. The diagnosis is verified at biopsy of the liver. In spite of scare symptoms, long-term follow-up detects progression of the disease in more than 1/3 of the patients. Cirrhosis arose in 1/6 of the patients. Standard NASH treatment is absent, though elimination of the provoking factors, therapy with antioxidant drugs and ursodesoxycholic acid produce a favourable effect.
Podymova
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D000975:Antioxidants / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004032:Diet; D005234:Fatty Liver / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D011379:Prognosis; D012307:Risk Factors
D000975:Antioxidants