Non-Alcoholic Steatohepatitis (NASH) Influences the Disease Progression of Chronic Hepatitis C
Toshiharu Matsumoto, Kanako Ogura. Juntendo University Nerima Hospital, Tokyo, Japan
Background: Non-alcoholic steatohepatitis (NASH) is a chronic liver injury with liver histology of steatosis, lobular inflammation and fibrosis (pericellular and perivenular) in nonalcoholic patients. The occasional occurrence of NASH in chronic hepatitis C (CH-C) has been reported, but the influences of NASH on the disease progression of CH-C are obscure. Therefore, in the present study, we examine the influences of NASH on the disease progression of CH-C.
Design: Liver biopsies from 400 cases with CH-C were examined histologically. The histology of CH was evaluated by the activity scores (A0, A1, A2, and A3) and fibrosis scores (F0, F1, F2, F3, and F4 = cirrhosis). NASH was evaluated by the grading (G1, G2, G3, and G4) and staging system (S1, S2, S3, and S4) according to the Brunt system (Brunt EM, et al. Am J Gastroenterol 94:2467-2474, 1999).
Results: A morphological pattern of NASH was present in 69 cases (69/400, 17%). The incidence of NASH did not correlate to the degree of activity and fibrosis of CH-C. In the 69 cases with NASH, the grade of NASH and the activity of CH-C did not correlate, but the stage of NASH and the fibrosis of CH-C significantly correlated (P < 0.001). In 18 cases (10 with F3, A2, and 8 with F3, A3) with NASH, various fibrosis patterns (portal, periportal, septal, pericellular and perivenular) causing both CH-C and NASH were admixed.
|A0||6/37 (16%)||5/17 (29%)||0/1 (0%)||0/1 (0%)||0 (0%)|
|A1||5/71 (7%)||18/111 (16%)||4/18 (22%)||0/10 (0%)||0/11 (0%)|
|A2||0/5 (0%)||0/14 (0%)||10/35 (28%)||10/27 (37%)||3/20 (15%)|
|A3||0/1 (0%)||0/2 (0%)||0/2 (0%)||8/11 (72%)||0/6 (0%)|