Amarapurkar DN, Amarapurkar AD, Patel ND, Agal S, Baigal R, Gupte P, Pramanik S

Language: English
References: 23
Page: 30-33
PDF size: 45.49 Kb.

Text Extraction

Introduction: Nonalcoholic steatohepatitis (NASH) is common cause of chronic liver disease strongly associated with insulin resistance leading to fibrosis. No factors that determine increasing fibrosis have been well recognized. Liver biopsy is considered as gold standard for diagnosis and prognosis of this disease. Aim: To identify independent predictive factors of liver fibrosis in patients of NASH with diabetes. Material and methods: During the year 2001 and 2002 total 36 patients of NASH associated with diabetes were included in the study. The diagnosis of NASH was based on 1) presence of steatosis, inflammation and ballooning on liver biopsy 2) Intake of alcohol ‹ 20 gm of ethanol per week 3) Exclusion of other liver diseases. Patients were labeled as diabetic if random glucose was › 200 mg/dL or fasting glucose more than 140 mg/dL on 2 occasion or having documented use of oral hypoglycemic medications or insulin. Clinical and biochemical variables such as age, sex, obesity, hypercholesterolemia, AST, ALT and AST: ALT were examined for predictors of fibrosis using univariate and multiple regression statistical analysis. Obesity was defined as BMI › 30 for both males and females. Hypercholesterolemia was considered when fasting cholesterol level was above 95th percentile of normal on at least 2 occasions. Fibrosis was noted as present or absent on histology. Results: Of 36 patients 17 were females and 19 males with age range of 25 to 75 years, mean age 50.8 years. Fibrosis was present in 11 (30.5%) and absent in 25 (69.4%) patients. Univariate and multiple correlations co-efficient failed to detect significant association of fibrosis with above mentioned variables. However multiple regression and logistic regression analysis (MLR) detected statistical significance for AST, ALT levels and AST: ALT ratio between fibrosis and no fibrosis in 80.6% patients. Conclusion: There is no definite noninvasive test that helps to predict liver fibrosis however AST, ALT levels and AST: ALT ratio may help to determine the fibrosis in patients of NASH with diabetes in majority of cases.

REFERENCES

1. Sanyal A. Nonalcoholic steatohepatitis. Indian J Gastroenterol 2001; 20(suppl): C64-C70.

2. Amarapurkar DN, Amarapurkar AD. Nonalcoholic steatohepatitis: Clincopathological profile. JAPI 2000; 48: 311-313.

3. Teli MR, James OFW, Burt AD, Bennett MK, Day CP. The natural history of non-alcoholic fatty liver: a follow of study. Hepatology 1995; 22: 1714-1719.

4. Brunt EM. Nonalcoholic steatohepatitis: definition and pathology. Semin Liver Dis 2001; 21: 3-16.

5. Caldwell SH, Oelsner DH, Iezzani JC, Hespenheide EE, Battle EH, Driscoll CJ. Cryptogenic cirrhosis: clinical characterization and risk factors for underlying disease. Hepatology 1999; 29: 664-669.

6. Neuschwander-Tetri BA, Caldwell SH. Nonalcoholic steatohepatitis: summary of an AASLD single topic conference. Hepatology 2003; 37: 1202-19.

7. Farrell GC. Non-alcoholic steatohepatitis: what is it and why is it important in the Asia-Pacific region? J Gastroenterol Hepatol 2003; 18: 124-38.

8. Mofrad P, Contos MJ, Haque M, Sargeant C, Fisher RA, Luketic VA, et al. Clinical and histologic spectrum of non-alcoholic fatty liver disease associated with normal ALT values. Hepatology 2003; 37: 1286-1292.

9. Agarwal SR, Malhotra V, Sakhuja P, Sarin SK. Clinical, biochemical and histological profile of nonalcoholic steatohepatitis. Indian J Gastroenterol 2001; 20: 183-186.

10. Sanyal AJ. Nonalcoholic fatty liver disease in the Indian subcontinent: a medical consequence of globalization? Indian J Gastroenterol 2001; 20: 215-216.

11. Diehl AM. Nonalcoholic steatohepatitis. Semin Liver Disease 1999; 19: 221-229.

12. Angulo Paul, Keach JC, Batts KP, Lindor KD. Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology 1999; 30: 1356-1362.

13. Kumar KS, Malet PF. Nonalcoholic steatohepatitis. Mayo Clin Proc 2000; 75: 733-739.

14. Lee RG. Nonalcoholic steatohepatitis: tightening the morphological screws on a hepatic rambler. Hepatology 1995; 21: 1742-1743.

15. Garcia-Monzon C, Martin-Perez E, Iacono OL, Fernandez-Bermejo M, Majano PL, Apolinario A, Larranaga E, Moreno-Otero R. Characterization of pathogenic and prognostic factors of nonalcoholic steatohepatitis associated with obesity. J Hepatol 2000; 33: 716- 724.

16. Harrison SA, Kadakia S, Lang KA, and Schenker S. Nonalcoholic steatohepatitis: what we know in the next millennium. Am J Gasteroenterol 2002; 97: 2714-2724.

17. Ramchandran A. Epidemiology of type 2 diabetes in Indians. J Indian Med Asso 2002; 100: 425-427.

18. Paulose KP. Risk factors in NIDDM. J Assoc Physicians India 1998; 46: 402.

19. Nanji AA, French SW, Freeman JB. Serum alanine aminotransferase to aspartate aminotransferase ratio and degree of fatty liver in morbidly obese patients. Enzymes 1986; 36: 266-269.

20. Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterol 1999; 116: 1413-1419.

21. Sorbi D, McGill DB, Thistle JL, Therneau TM, Henry J, Lindor KD. An assessment of the role of liver biopsies in asymptomatic patients with chronic liver test abnormalities. Am J Gastroenterol 2000; 95: 3206-3210.

22. Mofrad PS, Sanyal AJ. Nonalcoholic fatty liver disease, Medscape General medicine 2003; 5(2).

23. Shimada M, Hashimoto E, Kaneda H, Noguchi S, Hayashi N. Nonalcoholic steatohepatitis: risk factors for liver fibrosis. Hepatol Res 2002; 24: 429-438.