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Steatohepatitis (also known as fatty liver disease) is a type of liver disease, characterized by inflammation of the liver with concurrent fat accumulation in liver (steato-, meaning "fat", hepatitis, meaning "inflammation of the liver"). More deposition of fat in the liver is termed steatosis, and together these constitute fatty liver changes.

Classically seen in alcoholics as part of alcoholic liver disease, steatohepatitis also is frequently found in people with diabetes and obesity and it is related to metabolic syndrome. When not associated with excessive alcohol intake, it is referred to as nonalcoholic steatohepatitis, or NASH and is the progressive form of the relatively benign non-alcoholic fatty liver disease.^[1] Steatohepatitis of either etiology may progress to cirrhosis, and NASH is now believed to be a frequent cause of unexplained cirrhosis (at least in Western societies). NASH is also associated with lysosomal acid lipase deficiency.

Pathophysiology[edit]

Steatohepatitis is characterized microscopically by hepatic fat accumulation (steatosis), mixed lobular inflammation, ballooning degeneration of hepatocytes (sometimes with identifiable Mallory bodies), glycogenated hepatocyte nuclei, and pericellular fibrosis. The "chicken wire" pattern of the pericellular fibrosis, which affects portal areas only secondarily in later stages, is very characteristic and is identified on trichrome stains.^[2]

Treatment[edit]

Recent studies suggest diet, exercise, and antiglycemic drugs may alter the course of the disease. A randomized controlled trial found, "pioglitazone led to metabolic and histologic improvement in subjects with nonalcoholic steatohepatitis".^[3]

As of 2007, no treatment has yet emerged as the "gold standard". General recommendations include improving metabolic risk factors and reducing alcohol intake.^[4] However, vitamin E can improve some symptoms of NASH and was superior to insulin sensitizer in one large study. In the Pioglitazone versus Vitamin E versus Placebo for the Treatment of Nondiabetic Patients with Nonalcoholic Steatohepatitis (PIVENS) trial, for patients with NASH but without diabetes mellitus, the use of very high dosages of vitamin E (800 IU/day) for four years was associated with a significantly higher rate of improvement than placebo (43% vs. 19%) in the primary outcome. The primary outcome was an improvement in certain histological features as measured by biopsy, but it did not improve fibrosis. Pioglitazone, an insulin sensitizer, improved some features of NASH, but not the primary outcome, and resulted in a significant weight gain (mean 4.7 kilograms) which persisted after pioglitazone was discontinued.^[5]

Prognosis[edit]

A retrospective cohort study concluded, "liver failure is the main cause of morbidity and mortality in NASH-associated cirrhosis. The prognosis is either similar or less severe than HCV-cirrhosis."^[6]

History[edit]

NASH was first described in 1980 in a series of patients of the Mayo Clinic.^[7] Its relevance and high prevalence were recognized mainly in the 1990s. Some think NASH is a diagnosis of exclusion, and many cases may be in fact be due to other causes.^[8]

References[edit]

^ Vuppalanchi R, Chalasani N (January 2009). "Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: Selected practical issues in their evaluation and management". Hepatology 49 (1): 306–17. doi:10.1002/hep.22603. PMC 2766096. PMID 19065650. Cite uses deprecated parameters (help)
^ Yeh, Matthew; Brunt, Elizabeth (2007). "Pathology of Nonalcoholic Fatty Liver Disease". American Journal of Clinical Pathology: 837–841. Cite uses deprecated parameters (help)
^ Belfort R, Harrison SA, Brown K, et al. (2006). "A placebo-controlled trial of pioglitazone in subjects with nonalcoholic steatohepatitis". N. Engl. J. Med. 355 (22): 2297–307. doi:10.1056/NEJMoa060326. PMID 17135584.
^ Adams LA, Angulo P (2006). "Treatment of non-alcoholic fatty liver disease". Postgrad Med J 82 (967): 315–22. doi:10.1136/pgmj.2005.042200. PMC 2563793. PMID 16679470.
^ Sanyal AJ, Chalasani N, Kowdley KV, et al. (May 2010). "Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis". N. Engl. J. Med. 362 (18): 1675–85. doi:10.1056/NEJMoa0907929. PMC 2928471. PMID 20427778. Cite uses deprecated parameters (help)
^ Hui JM, Kench JG, Chitturi S, et al. (2003). "Long-term outcomes of cirrhosis in nonalcoholic steatohepatitis compared with hepatitis C". Hepatology 38 (2): 420–7. doi:10.1053/jhep.2003.50320. PMID 12883486.
^ Ludwig J, Viggiano TR, McGill DB, Oh BJ (1980). "Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease". Mayo Clin Proc 55 (7): 434–438. PMID 7382552.
^ Cassiman D, Jaeken J (2008). "NASH may be trash". Gut 57 (2): 141–4. doi:10.1136/gut.2007.123240. PMID 18192446.

External links[edit]

Hepatitis C Long-Term Outcomes of Cirrhosis in Nonalcoholic Steatohepatitis Compared With Hepatitis C

UpToDate Contents

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1. 成人における非アルコール性脂肪性肝疾患（NAFLD）の疫学、臨床的特徴、および診断 epidemiology clinical features and diagnosis of nonalcoholic fatty liver disease in adults
2. 成人における非アルコール性脂肪肝疾患の自然経過およびマネージメント natural history and management of nonalcoholic fatty liver disease in adults
3. アルコール性脂肪性肝炎およびアルコール性肝硬変の臨床症状および診断 clinical manifestations and diagnosis of alcoholic fatty liver disease and alcoholic cirrhosis
4. 小児および思春期における肥満の併存疾患および合併症 comorbidities and complications of obesity in children and adolescents
5. 肝生検標本の解釈 interpretation of liver biopsy specimens

English Journal

Fetuin-A mRNA expression is elevated in NASH compared with NAFL patients.

Kahraman A, Sowa JP, Schlattjan M, Sydor S, Pronadl M, Wree A, Beilfuss A, Kilicarslan A, Altinbaş A, Bechmann LP, Syn WK, Gerken G, Canbay A.Source*Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany.
Clinical science (London, England : 1979).Clin Sci (Lond).2013 Oct 1;125(8):391-400. doi: 10.1042/CS20120542.
Fetuin-A is a pro-inflammatory protein expressed by hepatocytes. Its course in morbidly obese patients with NAFLD (non-alcoholic fatty liver disease) following weight loss by BAS (bariatric surgery) has not been fully elucidated yet. In the present study, we prospectively examined the effects of wei
PMID 23627434

Non-alcoholic fatty liver disease is associated with an increased prevalence of atrial fibrillation in hospitalized patients with Type 2 diabetes.

Targher G, Mantovani A, Pichiri I, Rigolon R, Dauriz M, Zoppini G, Morani G, Vassanelli C, Bonora E.Source*Section of Endocrinology, Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
Clinical science (London, England : 1979).Clin Sci (Lond).2013 Sep 1;125(6):301-9. doi: 10.1042/CS20130036.
NAFLD (non-alcoholic fatty liver disease) and AF (atrial fibrillation) are two pathological conditions that are highly prevalent in developed countries and share multiple risk factors. The relationship between NAFLD and AF in Type 2 diabetes is currently unknown. We studied a hospital-based sample
PMID 23596966

Resistance exercise improves autonomic regulation at rest and haemodynamic response to exercise in non-alcoholic fatty liver disease.

Jakovljevic DG, Hallsworth K, Zalewski P, Thoma C, Klawe JJ, Day CP, Newton J, Trenell MI.SourceInstitute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK. djordje.jakovljevic@newcastle.ac.uk
Clinical science (London, England : 1979).Clin Sci (Lond).2013 Aug;125(3):143-9. doi: 10.1042/CS20120684.
Autonomic dysfunction has been reported in patients with NAFLD (non-alcoholic fatty liver disease) and is associated with clinical presentations. To date, there are no therapies to improve autonomic regulation in people with NAFLD. The present study defines the impact of a short-term exercise progra
PMID 23458257

Japanese Journal

Insufficiency of phosphatidylethanolamine N-methyltransferase is risk for lean non-alcoholic steatohepatitis

Scientific Reports 6, 21721, 2016-02-17
NAID 120005728628

肝臓疾患とオキシステロール (代謝) -- (臨床分野での進歩)

Annual review. 糖尿病・代謝・内分泌, 119-125, 2016
NAID 40020739713

経頸静脈的肝生検（TJLB）の有用性に関する後ろ向き検討

肝臓 57(6), 280-286, 2016
NAID 130005160952

Related Pictures

★リンクテーブル★

リンク元	「steat」「脂肪性肝炎」
拡張検索	「alcoholic steatohepatitis」「non-alcoholic steatohepatitis」「nonalcoholic steatohepatitis」

「steat」

Steatohepatitis
	Classification and external resources
	; Micrograph of steatohepatitis. Liver biopsy. Trichrome stain
ICD-10	K70.1, K76.0
ICD-9	571.0, 571.8
DiseasesDB	29786
eMedicine	article/170539
MeSH	C06.552.241

　　[★]

comb form

「脂肪」

ex.

「脂肪性肝炎」

　　[★]

steato
英: steatohepatitis
関: 脂肪肝

「alcoholic steatohepatitis」

　　[★]

アルコール性脂肪性肝炎

関: ASH

「non-alcoholic steatohepatitis」

　　[★] 非アルコール性脂肪性肝炎 NASH

「nonalcoholic steatohepatitis」