The Clinical And Pathological Features Of Non-alcoholic Steatohepatitis(NASH) Related Cirrhosis

BackgroundWith the advent of antiviral drugs,the spectrum of liver diseases worldwide has undergone dramatic changes.In North America,the liver transplantation rate of non-alcoholic steatohepatitis(HASH)-related decompensated liver cirrhosis has exceeded the rate of hepatitis C decompensated liver cirrhosis.At present,many clinical cohort studies of nonalcoholic fatty liver disease have confirmed that the degree of fibrosis is related to the prognosis of liver disease-related events and extra-hepatic events,and is the main factor that determines the prognosis and liver transplantation rate,which seriously threatens patient's life safety.PurposeIt highlights the clinical and histological characteristics of patients with NASH related cirrhosis,the diagnostic criteria for NASH related cirrhosis were updated or supplemented by comparison with other common clinical etiology of cirrhosis.Further validation of the clinical and pathological characteristics of NAFLD patients was conducted through a histologically confirmed NAFLD clinical cohort in mainland China.To investigate the clinical and histological characteristics of NASH related cirrhosis in patients with and without type 2 diabetes,and to determine the correlation between type 2 diabetes and progression of NASH related cirrhosis and liver fibrosis.The prediction of the histological characteristics related to the progression of non-alcoholic fatty liver disease fibrosis lays a foundation for the exploration of the occurrence and development mechanism of NASH related cirrhosis.Methods1.The subjects of this study include histologically confirmed NAFLD patients,cryptogenic cirrhosis with at least one metabolic disorder,chronic viral hepatitis B cirrhosis,autoimmune liver cirrhosis and viral hepatitis C cirrhosis from January 1995 to December 2018 in the liver disease center of nanfang hospital.All patients in this study were more than 18 years old.2.General clinical and related biochemical indexes and imaging data were collected from all included patients.Biochemical indexes were collected before or after liver biopsy within 7 days.3.To analyze the clinical and histological differences between NAFL-NASH and NASH related cirrhosis or advanced liver fibrosis.4.To analyze the clinical and histological characteristics of NASH related cirrhosis.5.To analyze the clinical and histological characteristics of NASH related cirrhosis patients with or without type 2 diabetes mellitus.Results1.NASH-related patients with advanced liver fibrosis or cirrhosis(N=22 cases)were older than NAFL and NASH patients(mean 49.5 years and 36 years,P=0.00),patients with diabetes and hypertension(the rates of diabetes was 42.9%and 10.5%respectively,and the rates of hypertension were 48%and 8.8%respectively,P =0.00).2.There was no correlation between type 2 diabetes and progression of NAFLD fibrosis(r=-1.41,p=0.45).3.Inflammatory encapsulation of lipid degeneration and balloon-like hepatocytes and vacuolar nuclei are histological features in the progression of NASH fibrosis(P<0.05).4.Patients who have intact pseudolobules with NASH-related cirrhosis(N=7 cases)had higher number of steatosis pseudolobes and higher percentage of steatosis(P<0.05).5.There were statistically significant differences in the percentage of ballooning or steatosis liver cell with inflammatory cell surrounded in NASH cirrhosis,chronic viral hepatitis B cirrhosis,autoimmune cirrhosis,and chronic viral hepatitis C cirrhosis(28.6%,7.1%,57.1%,and 46.2%,respectively)(P<0.05).6.In the progression of NASH fibrosis,fatty degeneration,ballooning hepatocytes,inflammatory cirrhosis,and balloon-like hepatocytes all decreased,while inflammation in the portal area(within the fibrous septum)increased(P<0.05)Conclusion1.The diagnosis of NASH-related cirrhosis should be increased:cryptogenic cirrhosis with at least one metabolic index.2.The susceptible population of NASH-related cirrhosis is elderly patients,or with type 2 diabetes or hypertension,hyperlipidemia or other metabolic diseases.3.Inflammatory cells surrounding ballooning hepatocytes are histologic features in the progression of NASH fibrosis,but they are not speci:fic histologic features of NASH associated progressive liver fibrosis or cirrhosis.4.The prominentlly histological features of NASH-related cirrhosis were the degree of steatosis.5.In the progression of NASH fibrosis,fatty degeneration,ballooning hepatocytes,inflammatory cirrhosis,and balloon-like hepatocytes all decreased,while inflammation in the portal area(within the fibrous septum)increased(P<0.05).