Relação de marcadores do metabolismo do ferro com a intensidade da esteato hepatite não alcoólica (EHNA) em obesos
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Data
2016-06-24
Autores
Silva, Marise Pereira da [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
A doença hepática gordurosa não alcoólica (DHGNA) é a alteração mais comum do metabolismo hepático, associada à obesidade, resistência à insulina e à síndrome metabólica. Compreende amplo espectro de alterações, que tem em comum a esteatose, em indivíduos que não consomem álcool. Além da sobrecarga de ingestão calórica, outros fatores como alterações do metabolismo do ferro podem estar relacionados à patogênese ou progressão da DHGNA. Analisamos no presente estudo as possíveis relações de marcadores do metabolismo do ferro com a intensidade das lesões hepáticas na DHGNA em indivíduos obesos. Foram estudados 88 indivíduos adultos, de ambos os gêneros, obesos (IMC >30), com diagnóstico histológico de DHGNA, acompanhados no ambulatório de Gastroenterologia e Hepatologia da FMB-Unesp. Os marcadores do metabolismo do ferro avaliados foram: níveis séricos de ferro, ferritina e transferrina, bem como o índice de saturação da transferrina (IST). A presença e intensidade da deposição de ferro no parênquima hepático foram investigadas pelo método histoquímico do Azul da Prússia (Perls). A intensidade da esteatose e o grau de fibrose foram avaliados nas biópsias hepáticas. Dos 88 indivíduos avaliados, 31 (35,2 %) apresentaram aumento dos níveis séricos de ferritina e 12 (13,6%) apresentaram valores de IST acima de 45 %. A avaliação histológica, das biópsias hepáticas, demonstrou a presença de fibrose em 48/88 casos (54,54%), sendo 21/88 (23,86%) de intensidade leve e 27/88 (30,68%) casos moderada/grave. A investigação da presença de hemossiderina demonstrou depósitos granulares finos no citoplasma dos hepatócitos periportais em 17/88 biópsias (19,32%). Não houve associação da presença de hemossiderina no parênquima hepático com a intensidade da fibrose. A análise de regressão logística identificou a presença de DMT2 ou glicemia de jejum > 100, dislipidemia e a presença de inflamação mista (lobular e portal) como fatores independentemente associados com a fibrose. Os resultados do presente estudo demonstraram que a presença do ferro no parênquima hepático é discreta em indivíduos obesos com DHGNA e provavelmente provavelmente não relacionada à patogênese ou progressão das lesões hepáticas que ocorrem nesta entidade.
The nonalcoholic fatty liver disease (NAFLD) is the most common modification of hepatic metabolism associated with obesity, insulin resistance and the metabolic syndrome. It comprises wide spectrum of changes, which have in common steatosis in individuals who do not consume alcohol. Besides calorie intake overload, other factors such as iron metabolism disorders may be related to the pathogenesis or progression of NAFLD. We analyzed in the present study the possible relationship of iron metabolism markers with the severity of liver injury in NAFLD in obese individuals. 88 adult subjects were studied, of both genders, obese (BMI> 30), with histological diagnosis of NAFLD, from ambulatory of gastroenterology and hepatology - FMB-Unesp. The markers of iron metabolism evaluated were: serum iron, transferrin and ferritin as well as the transferrin saturation index (STI). The presence and intensity of iron deposition in the liver parenchyma were investigated by histochemical method of Prussian blue (Perls). The intensity of steatosis and degree of fibrosis in liver biopsies were evaluated. Of the 88 individuals evaluated, 31 (35.2%) showed increased serum ferritin levels and 12 (13.6%) presented IST values above 45%. Histological evaluation of liver biopsies showed the presence of fibrosis in 48/88 cases (54.54%) and 21/88 (23.86%) mild and 27/88 (30.68%) moderate cases /serious. The investigation showed the presence of hemosiderin deposits in fine granular cytoplasm of periportal hepatocytes in 17/88 biopsies (19.32%). There was no association between the presence of hemosiderin in the liver parenchyma with the intensity of fibrosis. Logistic regression analysis identified the presence of T2DM or fasting glucose > 100, dyslipidemia and the presence of mixed inflammation (lobular and portal) as factors independently associated with fibrosis. The results of this study demonstrated that the presence of iron in the liver parenchyma is slight in obese subjects with NAFLD and probably not related to the pathogenesis or progression of liver damage occurring in this entity.
The nonalcoholic fatty liver disease (NAFLD) is the most common modification of hepatic metabolism associated with obesity, insulin resistance and the metabolic syndrome. It comprises wide spectrum of changes, which have in common steatosis in individuals who do not consume alcohol. Besides calorie intake overload, other factors such as iron metabolism disorders may be related to the pathogenesis or progression of NAFLD. We analyzed in the present study the possible relationship of iron metabolism markers with the severity of liver injury in NAFLD in obese individuals. 88 adult subjects were studied, of both genders, obese (BMI> 30), with histological diagnosis of NAFLD, from ambulatory of gastroenterology and hepatology - FMB-Unesp. The markers of iron metabolism evaluated were: serum iron, transferrin and ferritin as well as the transferrin saturation index (STI). The presence and intensity of iron deposition in the liver parenchyma were investigated by histochemical method of Prussian blue (Perls). The intensity of steatosis and degree of fibrosis in liver biopsies were evaluated. Of the 88 individuals evaluated, 31 (35.2%) showed increased serum ferritin levels and 12 (13.6%) presented IST values above 45%. Histological evaluation of liver biopsies showed the presence of fibrosis in 48/88 cases (54.54%) and 21/88 (23.86%) mild and 27/88 (30.68%) moderate cases /serious. The investigation showed the presence of hemosiderin deposits in fine granular cytoplasm of periportal hepatocytes in 17/88 biopsies (19.32%). There was no association between the presence of hemosiderin in the liver parenchyma with the intensity of fibrosis. Logistic regression analysis identified the presence of T2DM or fasting glucose > 100, dyslipidemia and the presence of mixed inflammation (lobular and portal) as factors independently associated with fibrosis. The results of this study demonstrated that the presence of iron in the liver parenchyma is slight in obese subjects with NAFLD and probably not related to the pathogenesis or progression of liver damage occurring in this entity.
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Palavras-chave
Doença hepática, Esteato hepatite não alcoólica, Metabolismo do ferro, Obesidade, Liver desease, Nonalcoholic steatohepatitis, Obesity, Iron metabolism