非酒精性脂肪性肝病儿童肝组织病理特征分析

刘敏; 陈卫坚; 周峥珍; 覃小梅; 文容; 姜楠; 匡林芝; 郑台青; 张丽琼; 李双杰

doi:10.3969/j.issn.1001-5256.2023.05.021

非酒精性脂肪性肝病儿童肝组织病理特征分析

DOI: 10.3969/j.issn.1001-5256.2023.05.021

a.
湖南省儿童医院病理科，长沙 410000
b.
湖南省儿童医院肝病中心，长沙 410000

基金项目:

湖南省卫生健康委科研项目计划 (202206014267)

伦理学声明：本研究方案于2022年8月30日经由湖南省儿童医院医学伦理委员会审批，批号：HCHLL-2020-52。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：刘敏负责收集、分析数据和论文撰写；陈卫坚、周峥珍、覃小梅、文容、姜楠对文章的知识性内容进行补充；匡林芝、郑台青、张丽琼负责实验操作；李双杰负责课题设计、指导论文撰写。

详细信息

通信作者:
李双杰，2273858951@qq.com (ORCID: 0000-0002-3792-6793)

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出版历程
- 收稿日期: 2022-09-02
- 录用日期: 2022-11-09
- 出版日期: 2023-05-20

Histopathological characteristics of the liver in children with non-alcoholic fatty liver disease

a.
Department of Pathology, Hunan Children's Hospital, Changsha 410000, China
b.
Liver Disease Center, Hunan Children's Hospital, Changsha 410000, China

Research funding:

Research Project Plan of Hunan Provincial Health Commission (202206014267)

More Information

Corresponding author: LI Shuangjie, 2273858951@qq.com(ORCID: 0000-0002-3792-6793)

摘要

- 非酒精性脂肪性肝病 /
- 病理学, 临床 /
- 儿童
- Non-alcoholic Fatty Liver Disease /
- Pathology, Clinical /
- Child

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图 1 1区交界型NASH(HE染色，×20)

注：以门静脉区为中心的腺泡1区(P)周边见大量肝细胞脂肪变性，而腺泡3区(V)不明显。

Figure 1. Borderline zone 1 NASH(HE staining, ×20)

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图 2 3区交界型NASH(HE染色，×20)

注：腺泡3区(V)周边见大量肝细胞脂肪变性，而腺泡1区(P) 无脂肪变性。

Figure 2. Borderline zone 3 NASH(HE staining, ×20)

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图 3 桥接纤维化及肝硬化

注：a, 桥接纤维化，附近两个门静脉区发出的纤维间隔已连接(Masson染色，×20); b, 肝硬化，附近两个门静脉区发出的纤维间隔分割包饶肝细胞，形成假小叶(HE染色，×20)。

Figure 3. Bridging fibrosis and cirrhosis

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图 4 不同程度NAS评分图(HE染色，×20)

注：a, 2分，脂肪变性(1分)，小叶炎症(1分)，气球样变(0分)；b, 5分，脂肪变性(2分)，小叶炎症(1分)，气球样变(2分)；c, 7分，脂肪变性(3分)，小叶炎症(2分)，气球样变(2分)。

Figure 4. NAS of different degrees(HE staining, ×20)

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表 1 87例NAFLD病例临床特点分析

Table 1. Clinical characteristics analysis of 87 NAFLD cases

项目	数值
年龄(岁)	11.0(10.0~12.3)
男性[例(%)]	83(95.4)
女性[例(%)]	4(4.6)
代谢综合征[例(%)]	44(50.6)
中心性肥胖[例(%)]	85(97.7)
2型糖尿病[例(%)]	4(4.6)
高血压[例(%)]	4(4.6)
高TG血症[例(%)]	55(63.2)
低HDL-C血症[例(%)]	39(44.8)
高non-HDL-C血症[例(%)]	23(26.4)
胰岛素抵抗[例(%)]	69(79.3)
高尿酸血症[例(%)]	66(75.9)

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表 2 87例NAFLD病例实验室数据

Table 2. Laboratory data of 87 NAFLD cases

项目	数值
WBC(×10⁹/L)	7.93±1.98
PLT(×10⁹/L)	321.95±77.20
Hb(g/L)	136.37±10.64
ALT(IU/L)	166.95±113.92
AST(IU/L)	83.82±61.98
GGT(IU/L)	66.09±83.22
ALP(U/L)	150.52±4.83
UA(μmol/L)	426.15±101.36
TG(mmol/L)	1.92±1.12
TC(mmol/L)	4.20±0.96
HDL-C(mmol/L)	1.05±0.26
non-HDL-C(mmol/L)	3.11±0.92
FBG(mmol/L)	5.09±1.52
注：UA，尿酸；FBG，空腹血糖。

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表 3 87例NAFLD病例病理特点分布情况

Table 3. Distribution of pathological characteristics of 87 NAFLD cases

项目	例数(%)
脂肪变性
1分(5%~33%)	14(16.1)
2分(34%~66%)	10(11.5)
3分(＞66%)	63(72.4)
小叶炎症
1分(＜2个炎症坏死灶)	29(33.3)
2分(2~4个炎症坏死灶)	55(63.2)
3分(＞4个炎症坏死灶)	3(3.4)
气球样变性
0分(无)	1(1.1)
1分(少见)	12(13.8)
2分(多见)	74(85.1)
门静脉区炎症
0分(无)	1(1.1)
1分(轻度)	66(75.9)
2分(中度)	18(20.7)
3分(重度)	2(2.3)
门静脉区纤维化
无	10(11.5)
有	77(88.5)
纤维化分级
F0(无纤维化)	10(11.5)
F1(3区窦周/门静脉周围)	42(48.3)
F2(窦周和门静脉/门静脉周围)	19(21.8)
F3(桥接纤维化)	14(16.1)
F4(肝硬化)	2(2.3)
NAS评分情况
0~2分	1(1.1)
3~4分	10(11.5)
5~8分	76(87.4)
NAFLD模式
非NASH	6(6.9)
1区交界型	13(14.9)
3区交界型	6(6.9)
确定NASH	62(71.3)

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表 4 FIB-4对NAFLD肝纤维化、显著肝纤维化、进展期肝纤维化的诊断价值

Table 4. Diagnostic value of FIB-4 in NAFLD fibrosis, significant fibrosis and advanced fibrosis

纤维化阶段	AUC	95%CI	最佳临界值	P值	灵敏度(%)	特异度(%)	阴性预测值(%)	阳性预测值(%)	阴性似然比	阳性似然比
≥F1	0.636	0.410~0.863	0.16	0.147	79.2	60.0	23.8	92.4	0.35	1.98
≥F2	0.654	0.538~0.770	0.23	0.015	51.4	75.0	69.6	58.1	0.31	2.06
≥F3	0.618	0.462~0.774	0.27	0.154	40.0	80.6	86.4	28.6	0.74	2.06

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