Der Pathologe

, Volume 31, Issue 3, pp 225–237 | Cite as

Histopathologische Diagnose der nichtalkoholischen und alkoholischen Fettlebererkrankung

Konsensusbasierte Leitlinie der Stufe 2
  • A. Tannapfel
  • H. Denk
  • H.P. Dienes
  • C. Langner
  • P. Schirmacher
  • M. Trauner
  • B. Flott-Rahmel
Übersichten

Zusammenfassung

Eine alkoholische (AFL) und eine nichtalkoholische Fettleber (NAFL) zeichnen sich durch eine Einlagerung von Lipiden in die Hepatozyten aus. Bei einer Beteiligung von >5% der Hepatozyten spricht man von „Verfettung“, bei >50% von einer „Fettleber“. Eine zusätzliche Entzündungsreaktion führt zur alkoholischen (ASH) oder nichtalkoholischen (NASH) Steatohepatitis. Eine Steatohepatitis liegt dann vor, wenn gemischtzellige entzündliche Infiltrate in den Leberläppchen nachweisbar sind und zusätzlich eine Leberzellschädigung in Form einer Ballonierung vorliegt.

Die Leberbiopsie ist der „Gold-Standard“ bei der Sicherung der Diagnose sowie der Bestimmung der entzündlichen Aktivität und möglichen Fibrose einer Fettlebererkrankung.

Die Differenzialdiagnose ASH – NASH kann allein aufgrund histologischer Kriterien im Allgemeinen nicht erfolgen. Verfettung, entzündliche Veränderungen und hepatozytäre Schädigungszeichen können in einem Score zusammengefasst die Basis zur Entscheidung bieten, ob eine Steatohepatitis vorliegt oder nicht.

Personen mit erhöhtem Risiko für die Entwicklung einer Fettleber besitzen ein erhöhtes Risiko, eine chemotherapieassoziierte Steatohepatitis (CASH) zu entwickeln.

Die kindliche NASH weist im Vergleich zur erwachsenen NASH histologische Unterschiede auf und zeigt sich klinisch zumeist nur durch eine geringe persistierende Erhöhung der Transaminasen.

Schlüsselwörter

Nichtalkoholische Steatohepatitis Alkoholische Steatohepatitis Fettleber Leberzirrhose Scoring 

Histopathological diagnosis of non-alcoholic and alcoholic fatty liver disease

Grade 2 consensus-based guidelines

Abstract

Both alcoholic (AFL) and non-alcoholic fatty liver (NAFL) are characterized by lipid deposition in hepatocytes. The diagnosis of steatosis is made when lipid deposition exceeds 5% of hepatocytes, while involvement of more than 50% is called “fatty liver “. An additional inflammatory reaction leads to alcoholic (ASH) or non-alcoholic steatohepatitis (NASH). Steatohepatitis is present when both inflammatory infiltrates of mixed cells in the small liver lobules as well as liver cell injury in terms of ballooning can be detected.

Liver biopsy represents the “gold standard” for confirming diagnosis and determining inflammatory activity and potential fibrosis of fatty liver disease.

The differential diagnosis of ASH–NASH cannot be made on the basis of histological criteria alone. Steatosis, inflammatory changes and hepatocytic injury can be semiquantified as a “Brunt Score” or “NAS” (NAFLD activity score), providing the basis on which to decide whether or not steatohepatitis is present.

People at increased risk of developing a fatty liver possess an increased risk of developing chemotherapy-associated steatohepatitis (CASH).

Histologically, pediatric NASH differs from adult NASH and is often only clinically manifest through a mild if persistent elevation in transaminases.

Keywords

Non-alcoholic steatohepatitis Alcoholic steatohepatitis Fatty liver Liver cirrhosis Scoring 

Notes

Interessenkonflikt

Die korrespondierende Autorin gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer Medizin Verlag 2010

Authors and Affiliations

  • A. Tannapfel
    • 1
  • H. Denk
    • 2
  • H.P. Dienes
    • 3
  • C. Langner
    • 2
  • P. Schirmacher
    • 4
  • M. Trauner
    • 5
  • B. Flott-Rahmel
    • 1
  1. 1.Institut für PathologieRuhr-Universität BochumBochumDeutschland
  2. 2.Institut für PathologieMedizinische Universität GrazGrazÖsterreich
  3. 3.Institut für PathologieUniversität zu KölnKölnDeutschland
  4. 4.Pathologisches InstitutUniversitätsklinikum HeidelbergHeidelbergDeutschland
  5. 5.Klinische Abteilung für Gastroenterologie und HepatologieMedizinische Universität GrazGrazÖsterreich

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