Prevalência da doença hepática gordurosa não alcoólica definida pela biópsia hepática: o verdadeiro espectro em diabéticos tipo II

• Ano de defesa: 2013
• Autor(a) principal: Machado, Lilian
• Orientador(a): Figueiredo, Fátima Aparecida Ferreira
• Banca de defesa: Leite, Nathalie Carvalho , Gomes, Marilia de Brito , Cotrim, Helma Pinchemel
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade do Estado do Rio de Janeiro
• Programa de Pós-Graduação: Programa de Pós-Graduação em Ciências Médicas
• Departamento: Centro Biomédico::Faculdade de Ciências Médicas
• País: BR
• Palavras-chave em Português: Doença hepática gordurosa não alcoólica; Esteatohepatite; Diabetes mellitus; Biópsia hepática; Fibrose; ALT
• Palavras-chave em Inglês: Non-alcoholic fatty liver disease; Steatohepatitis; Diabetes Mellitus; Liver biopsy; Fibrosis; ALT
• Área do conhecimento CNPq: CNPQ::CIENCIAS DA SAUDE::MEDICINA
• Link de acesso: http://www.bdtd.uerj.br/handle/1/8734

Non-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease worldwide, especially in some groups of patients, as type II diabetic. Liver biopsy remains the gold standard method for diagnosis of the disease. Current prevalences of NAFLD and its subtypes, as steatohepatitis (NASH), can be underestimated due to the non invasive tests for diagnosis or overestimated due to liver biopsy in patients selected by changes in ultrasonography (US) or aminotransferases. The objectives of this study were: define the prevalence of NAFLD (bland steatosis, NASH and cirrhosis) in type II diabetic patients, based on liver biopsy; quantify steatosis, inflammation and fibrosis when present; identify predictive factors of NAFLD, NASH and significant fibrosis (&#8805; stage 2) and analyse the value of aminotransferases and abdominal US for diagnosis of NASH and significant fibrosis. All type II diabetic patients, from 18 to 70 years, consecutively evaluated in the outpatient Clinic of Diabetes Mellitus of a terciary care University Hospital, were considered for enrollment. Patients were excluded if they had positive serology for hepatitis B or C, other chronic liver diseases, used medications associated with steatosis or hepatotoxic drugs, consumed &#8805; 20g alcohol per day, had other serious diseases, grade III obesity, were pregnant or declined participation. From 396 patients evaluated, 85 were included. Patients were submitted to clinical and laboratory examinations, abdominal US and liver biopsy. The slides were analysed by two independent pathologists and graded according to NASH Clinical Research Network Scoring System. Agreement between pathologists was accessed by kappa coefficients (k) and factors independently associated to NAFLD, NASH and significant fibrosis by multivariate logistic regression. Prevalence of NAFLD was 92%, being 50% bland steatosis, 40% NASH and 2% cirrhosis. Agreement between pathologists (k) was 0,78. Steatosis was mild in the majority of patients with bland steatosis and mostly severe in NASH patients (p<0,001). Fibrosis occurred in 76% of NASH patients, being significant in 41% of them. Metabolic syndrome was independently associated to NAFLD, body mass index and increased waist circumference to NASH and alanine aminotransferase (ALT) to NASH and significant fibrosis. Metabolic syndrome was independently associated to NAFLD; body mass index and increased waist circumference were associated to NASH; and ALT was associated to NASH and significant fibrosis. Only one from 21 patients (5%) with normal US and ALT had NASH. The prevalence of NASH progressively increased as the steatosis grade on US and the liver enzymes got worse. Conclusion: Prevalence of NAFLD estimated by liver biopsy in T2DM patients without selection bias was very high. Although elevated, prevalence of NASH and significant fibrosis were lower than defined by studies with biopsies in patients with changes in US or aminotransferases. NASH was associated to severe steatosis on histology. Obesity was an important factor in NASH diagnosis. The best performance of ALT and US was in exclude severe subtypes of NAFLD when normal.