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استئاتوهپاتيت غيرالكلي
(Non-Alcoholic Steatohepatitis)
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كبد چرب غيرالكلي، استئاتو هپاتيت، پاتولوژي كبدي: هاي كليديواژه
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E-mail: [email protected]
1. macrovesicular fatty changes
2. Mallory bodies
3. random
4. desialylated
5. HBsAg
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����� ��� ��� ������(Non-Alcoholic Steatohepatitis)
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115
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116
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1383تابستان / 2شماره / سال نهم/ گوارش
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����� ��� ��� ������(Non-Alcoholic Steatohepatitis)
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Non-Alcoholic Steatohepatitis (NASH)
ABSTRACT
The term “Non- Alcoholic Steatohepatitis (NASH)” is applied when
sonographic and pathologic view of liver shows alcoholic hepatitis
changes without history of alcohol consumption. Radiologic findings can
easily make the diagnosis and liver biopsy confirms the initial suspicion.
It is showed that up to 43.5% of patients with asymptomatic abnormal
liver transferases levels have some degrees of NASH, which suggest
the importance of being familiar with the issue and how to approach and
treat it. NASH is commonly accompanied with diabetes mellitus
(especially type II), obesity and hyperlipidemia. These findings support
the theory in which insulin resistance is the mainstay of NASH
pathophysiology. The natural history of NASH is unclear but surely it is
far better than alcoholic related liver disease. It is estimated that up to
8% of patients would meet cirrhosis, considering risk factors such as
obesity and features found in biopsy specimen. Steatosis,
polymorphonuclear lobular inflammation, ballooning degeneration,
hyaline- Mallory bodies and cirrhosis are among different pathologies
seen in biopsy. It is important to rule out other chronic liver diseases
including drug induced liver disease, chronic viral hepatitis, and
metabolic and autoimmune liver diseases to establish the diagnosis of
NASH. There is no definite treatment for NASH. Therapeutic measures
are categorized as reducing risk factors and using hepatocellular
protective agents. The former includes weight reduction, treating
hyperinsulinemia and diabetes, control of hypertriglyceridemia and
leptin. Protective agents are anti-oxidants like vitamin E and/ or C,
probucol, silymarin, ursodeoxycholic acid, reducing iron load, N-acetyl
cystein, food supplements and cytokines. Increasing rate of NASH is
reported among children and adolescences, which could be due to
growing amount of obesity in these age groups. Govaresh 2004; 9: 110-21
Keywords: Non-alcoholic fatty liver, Steatohepatitis, Liver pathology
Ebrahimi Daryani N
Gastroenterology Dept., Imam
Khomeini Hospital,
Tehran University of Medical
Sciences
Bahrami H
Imam Khomeini Hospital,
Tehran University of Medical
Sciences
Haghpanah B
Imam Khomeini Hospital,
Tehran University of Medical
Sciences
Hashtroudi AA
Imam Khomeini Hospital,
Tehran University of Medical
Sciences
Corresponding Author: Nasser Ebrahimi Daryani MD, No.
130. next to Shahid Naseri Ave.,
Valiasr Ave. Tehran, Iran.
Tel: +98 21 8799446
Fax: +98 21 8799840
E-mail:
Non-Alcoholic Steatohepatitis (NASH)
147
Govaresh\ Vol. 9\ No. 2\Summer 2004