Nonalcoholic fatty liver disease: RESULTS (Part 2)

In: Nonalcoholic fatty liver disease

9 Jul 2012

The 49 patients with NAFLD were categorized according to the type of changes in their liver biopsies (Table 4). The patients were divided into four groups: the steatosis only group consisted of patients with no or minimal evidence of fibrosis on biopsy; the NASH group were patients with fibrosis and presence of ballooning in zone 3; the NASH with cirrhosis group were those with cirrhosis attributed to NASH; and the total NASH group were patients with NASH with or without cirrhosis. In the steatosis only group, nine of the 13 patients had mild, two had moderate and two had severe steatosis. Of these patients, 69.2% were between the ages of 20 and 40 years. In contrast, patients with NASH or NASH with cirrhosis were considerably older, with only 26.6% and 0%, respectively, below the age of 40. The incidence of diabetes was also differed considerably between the groups. The steatosis only patients had no diabetes, while the patients with NASH or NASH with cirrhosis had a 36.1% incidence of diabetes. More importantly, in NASH patients with cirrhosis, the incidence of diabetes was 100%. The majority of patients identified with steatosis only and NASH had above average weights, were described to have truncal fat, and had a high incidence of increased total cholesterol or triglyceride concentrations (data not shown).

ALT was increased in the steatosis only group in 75% of patients compared with only 53.8% with increased AST. In contrast, both ALT (96.9%) and AST (84.6%) were increased in the NASH group. In addition, the mean rise of AST was significantly higher (P<0.05) in the NASH than in the steatosis only group, whereas the mean rise of ALT was almost equal in the two groups (Table 4). In contrast to the NASH group, patients with NASH and cirrhosis had a moderate rise in AST but no significant rise in ALT. The ratio of AST to ALT was compared in the four groups. As Table 4 shows, the ratio of AST to ALT was less then 1 in both the steatosis only and the NASH groups, and although this ratio tended to increase with advancing disease the difference did not reach statistical significance. Compared with both the steatosis only and the NASH groups, those with NASH and cirrhosis had a significantly higher ratio of AST to ALT at 2.34 (P<0.05). This group had only six patients but this result is in keeping with the increased AST to ALT ratio seen with other causes of cirrhosis. For the total NASH group, the ratio of AST to ALT was 1.0, trending to an increased AST to ALT ratio with advancing disease. However, the difference between the steatosis only and the total NASH groups did not reach statistical significance. Finally, ultrasound was useful in detecting fat in only 36.4% of patients with biopsies showing steatosis only compared with 79.2% of patients with NASH. The presence of fat was missed on ultrasound in 90% of patients with mild steatosis. buy cipro online –

 TABLE 4 Patient characteristics analyzed according to their histological findings

Variable Steatosis only (n=13) (26.5%) NASH (n=30) (61.2%) NASH and cirrhosis (n=6) (12.2%) Total NASH (n=36) (73.4%)
Age (years)
Mean ± SE 37.1±10.0 47.9±12.7* 57.7±8.8t 49.5±12.6*
20-40 (%) 9 (69.2) 8 (26.6)§ 0 (0)§ 8 (22.2)*
41-50 (%) 2 (15.4) 6 (20.0) 3 (50.0) 9 (25.0)
51-60 (%) 2 (15.4) 11 (36.7) 0 (0) 11 (30.6)
>60 (%) 0 (0) 5 (16.7) 3 (50.0)^ 8 (22.2)
Male sex (%) 7 (54) 16 (53.3) 2 (33.3) 18 (50)
Diabetes (%) 0 (0) 7 (23.3)** 6 (100)** 13 (36.1)*
Overweight (%) 8 (90.0) n=9 22 (92.0) n=24 6 (100) 28 (93.3) n=30
Obesity (%) BMI >30 4 (44.5) n=9 10 (41.7) n=24 3 (50) 13 (43.3) n=30
Fat on ultrasound (%) 4 (36.4) n=11 18 (79.2) n=23t NA NA
AST (U/L) (mean ± SD)tt 50.08±27.3 78.1±36.6** 65.4±26.3 76.7±36.9*
ALT (U/L) (mean ± SD)tt 106.1±79.9 108.2±61.6 48.1±28.3§§ 108.1±78.9
AST:ALT (mean ± SD)tt 0.63±0.43 0.75±0.34 2.34±.31l™ 1.0±1.21

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