[The evolution of ideas about nonalcohol fatty liver disease].
The aim of this study was to determine histological, clinical features and prognosis at patients with fatty gepatose and nonalcohol steatogepatite (NASG). The material of this study was analysis of clinical and laboratory manifestations in 74 patients with fatty gepatose of nonalcohol etiology that we have observed in 60-70th years of the twentieth century. All patients were performed liver puncture biopsy, 7 patients puncture performed twice, two--three times and two--four times. Thus we studded 91 punctate. Patients with fatty dystrophy I - II - III degree and I - II degree of fibrosis were included in the group of fat gepatose without inflammatory reaction (1st group, 54 patients), patients with fat-dystrophia II - III degree and III degree of fibrosis--in a group of fat gepatose with inflammatory reaction (Group 2, 20 patients). Patients classified earlier in a group of fat gepatose with inflammatory reaction, according to modern classification positions on histological characteristics of nonalcoholic steatogepatite.


RESULTS
Functional disorders of liver are often not captured in conventional biochemical tests. It characterized by urobilinogenuriya, delayed retention of bromsulfalein, gipertriglitseridemiya. ALAT activity slightly increased in patients with fatty gepatose and exceeded norm in 1,5-2,5 times. While at NASG activity of this enzyme was more than half the enhanced AsAT, and gamma-GTP. Nonalcoholic steatogepatite did not have specific clinical and biochemical features. Assessment of inflammation and fibrosis degree using ultrasound liver is difficult and non-reliable. Therefore, NASG diagnosis based on represented data of liver puncture biopsy. In a lengthy check-up we have 42 patients with fat gepatose and NASG--stabilization process was defined in 34 people. Development of cirrhosis found in 5 patients. After repeat biopsy in these patients on a background of fat liver dystrophy encountered a picture of developing micronodular cirrhosis. In 3 of them had repeated liver puncture through 1.5 years. One patient puncture performed three times at intervals of 4.5 years, initial signs of cirrhosis found only in the last biopsy. Another patient moved 4 puncture for 6 years hemochromatosis as an iron overload syndrome, and initial signs of cirrhosis identified through 3 years, in next 3 years progression of morphological features of cirrhosis weren't found.


CONCLUSIONS
Nonalcoholic steatogepatite is an independent disease, which should be remembered in differential diagnosis in patients with sustained ALAT and ASAT improvement in serum especially in presence of obesity, diabetes, hyperlipidaemia. The diagnosis was confirmed with biopsy of liver. Despite of oligosymptomatic course of the disease with long-term observation of more than one third of patients with evidence of progression of the process; cirrhosis development noted sixth of the patients, and more. Universally accepted treatment of NASG doesn't exists, although exclusion of provoking factors, therapy antioxidant drugs and ursodezoksiholevoy acid can have favorable effect. The study in 45 patients with NASG was adjusted an effective use of berlitione in the treatment of patients with nonalcoholic steatogepatite. At comparing different schemes of appointment preparations optimal effect were obtained in patients with berlitione dose 600 and 900 mg for two months.
Podymova
S D
SD
D000818:Animals; D003937:Diagnosis, Differential; D000431:Ethanol / Q000009:adverse effects; D005234:Fatty Liver / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology; D008111:Liver Function Tests; D011379:Prognosis; D012307:Risk Factors
D000431:Ethanol