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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 39 Issue 3
Mar.  2023
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Article Contents

Diagnosis of nonalcoholic fatty liver disease: The importance of pathology

DOI: 10.3969/j.issn.1001-5256.2023.03.002
Research funding:

Gansu Province Academic Innovative Promotion (2020B-016);

The Inner Project of the 1st hospital of Lanzhou University (ldyyyn2018-62)

More Information
  • Corresponding author: YANG Yongfeng, yyf1997@163.com (ORCID: 0000-0002-3214-0038)
  • Received Date: 2022-01-15
  • Accepted Date: 2022-02-20
  • Published Date: 2023-03-20
  • Histopathological evaluation based on liver biopsy is required to make a confirmed diagnosis of nonalcoholic fatty liver disease, differentiate nonalcoholic fatty liver (NAFL) from nonalcoholic steatohepatitis (NASH), and perform the grading and scoring of disease severity, while hematological and radiological examinations are often used in clinical practice. Although there have been a large number of studies on noninvasive models for fibrosis assessment and disease diagnosis in nonalcoholic fatty liver disease, the sensitivity and specificity of such models need to be further improved. This article reviews the main pathological features of NAFL and NASH, fibrosis and grading/staging/scoring systems, and the pathological diagnosis of NASH liver cirrhosis, in order to improve the awareness of the histological diagnosis of such disease among clinicians

     

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  • [1]
    LOOMBA R, ADAMS LA. The 20% rule of NASH progression: The natural history of advanced fibrosis and cirrhosis caused by NASH[J]. Hepatology, 2019, 70(6): 1885-1888. DOI: 10.1002/hep.30946.
    [2]
    SAXENA R. Practical hepatic pathology, a diagnostic approach[M]. 2nd edition. Philadelphia, PA: Elsevier, 2017.
    [3]
    BRIL F, BARB D, PORTILLO-SANCHEZ P, et al. Metabolic and histological implications of intrahepatic triglyceride content in nonalcoholic fatty liver disease[J]. Hepatology, 2017, 65(4): 1132-1144. DOI: 10.1002/hep.28985.
    [4]
    POUWELS S, SAKRAN N, GRAHAM Y, et al. Non-alcoholic fatty liver disease (NAFLD): a review of pathophysiology, clinical management and effects of weight loss[J]. BMC Endocr Disord, 2022, 22(1): 63. DOI: 10.1186/s12902-022-00980-1.
    [5]
    BRUNT EM, KLEINER DE, CARPENTER DH, et al. NAFLD: Reporting histologic findings in clinical practice[J]. Hepatology, 2021, 73(5): 2028-2038. DOI: 10.1002/hep.31599.
    [6]
    BRUNT EM. Pathology of fatty liver disease[J]. Mod Pathol, 2007, 20 (Suppl 1): S40-S48.
    [7]
    FELDSTEIN AE, WIECKOWSKA A, LOPEZ AR, et al. Cytokeratin-18 fragment levels as noninvasive biomarkers for nonalcoholic steatohepatitis: a multicenter validation study[J]. Hepatology, 2009, 50(4): 1072-1078. DOI: 10.1002/hep.23050.
    [8]
    DUAN Y, PAN X, LUO J, et al. Association of inflammatory cytokines with non-alcoholic fatty liver disease[J]. Front Immunol, 2022, 13: 880298. DOI: 10.3389/fimmu.2022.880298.
    [9]
    SANYAL AJ, HARRISON SA, RATZIU V, et al. The natural history of advanced fibrosis due to nonalcoholic steatohepatitis: data from the simtuzumab trials[J]. Hepatology, 2019, 70(6): 1913-1927. DOI: 10.1002/hep.30664.
    [10]
    BRUNT EM. Grading and staging the histopathological lesions of chronic hepatitis: the Knodell histology activity index and beyond[J]. Hepatology, 2000, 31(1): 241-246. DOI: 10.1002/hep.510310136.
    [11]
    LUO J, LIU LW, LIU JM, et al. Comparative study of clinicopathological features, and risk factors of advanced fibrosis between genders with non-alcoholic fatty liver disease[J]. Chin J Hepatol, 2021, 29(4): 356-361. DOI: 10.3760/cma.j.cn501113-20200203-00027.

    罗娟, 刘立伟, 刘纪民, 等. 非酒精性脂肪性肝病临床和病理特点及进展期纤维化危险因素性别差异的对比研究[J]. 中华肝脏病杂志, 2021, 29(4): 356-361. DOI: 10.3760/cma.j.cn501113-20200203-00027.
    [12]
    ANGULO P, KLEINER DE, DAM-LARSEN S, et al. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease[J]. Gastroenterology, 2015, 149(2): 389-397. e10. DOI: 10.1053/j.gastro.2015.04.043.
    [13]
    TIAN AP, YANG YF. A comparative analysis of pathological grading and staging systems for chronic hepatitis[J]. J Clin Hepatol, 2018, 34(11): 2271-2277. DOI: 10.3969/j.issn.1001-5256.2018.11.002.

    田爱平, 杨永峰. 慢性肝炎病理学分级分期评分系统比较[J]. 临床肝胆病杂志, 2018, 34(11): 2271-2277. DOI: 10.3969/j.issn.1001-5256.2018.11.002.
    [14]
    KLEINER DE, BRUNT EM, van NATTA M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease[J]. Hepatology, 2005, 41(6): 1313-1321. DOI: 10.1002/hep.20701.
    [15]
    BEDOSSA P, POITOU C, VEYRIE N, et al. Histopathological algorithm and scoring system for evaluation of liver lesions in morbidly obese patients[J]. Hepatology, 2012, 56(5): 1751-1759. DOI: 10.1002/hep.25889.
    [16]
    ALKHOURI N, de VITO R, ALISI A, et al. Development and validation of a new histological score for pediatric non-alcoholic fatty liver disease[J]. J Hepatol, 2012, 57(6): 1312-1318. DOI: 10.1016/j.jhep.2012.07.027.
    [17]
    CLEVELAND E, BANDY A, VANWAGNER LB. Diagnostic challenges of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis[J]. Clin Liver Dis (Hoboken), 2018, 11(4): 98-104. DOI: 10.1002/cld.716.
    [18]
    LONGERICH T, SCHIRMACHER P. Determining the reliability of liver biopsies in NASH clinical studies[J]. Nat Rev Gastroenterol Hepatol, 2020, 17(11): 653-654. DOI: 10.1038/s41575-020-00363-8.
    [19]
    CASTERA L, FRIEDRICH-RUST M, LOOMBA R. Noninvasive assessment of liver disease in patients with nonalcoholic fatty liver disease[J]. Gastroenterology, 2019, 156(5): 1264-1281. e4. DOI: 10.1053/j.gastro.2018.12.036.
    [20]
    KWOK R, TSE YK, WONG GL, et al. Systematic review with meta-analysis: non-invasive assessment of non-alcoholic fatty liver disease-the role of transient elastography and plasma cytokeratin-18 fragments[J]. Aliment Pharmacol Ther, 2014, 39(3): 254-269. DOI: 10.1111/apt.12569.
    [21]
    MIDDLETON MS, HEBA ER, HOOKER CA, et al. Agreement between magnetic resonance imaging proton density fat fraction measurements and pathologist-assigned steatosis grades of liver biopsies from adults with nonalcoholic steatohepatitis[J]. Gastroenterology, 2017, 153(3): 753-761. DOI: 10.1053/j.gastro.2017.06.005.
    [22]
    TAOULI B, SERFATY L. Magnetic resonance imaging/elastography is superior to transient elastography for detection of liver fibrosis and fat in nonalcoholic fatty liver disease[J]. Gastroenterology, 2016, 150(3): 553-556. DOI: 10.1053/j.gastro.2016.01.017.
    [23]
    WILDMAN-TOBRINER B, MIDDLETON MM, MOYLAN CA, et al. Association between magnetic resonance imaging-proton density fat fraction and liver histology features in patients with nonalcoholic fatty liver disease or nonalcoholic steatohepatitis[J]. Gastroenterology, 2018, 155(5): 1428-1435. e2. DOI: 10.1053/j.gastro.2018.07.018.
    [24]
    NOUREDDIN M, TRUONG E, GORNBEIN JA, et al. MRI-based (MAST) score accurately identifies patients with NASH and significant fibrosis[J]. J Hepatol, 2022, 76(4): 781-787. DOI: 10.1016/j.jhep.2021.11.012.
    [25]
    RINELLA ME, TACKE F, SANYAL AJ, et al. Report on the AASLD/EASL joint workshop on clinical trial endpoints in NAFLD[J]. J Hepatol, 2019, 71(4): 823-833. DOI: 10.1016/j.jhep.2019.04.019.
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