Clinical–liver, pancreas, and biliary tractProgressive Fibrosis in Nonalcoholic Steatohepatitis: Association With Altered Regeneration and a Ductular Reaction
Section snippets
Patients and Clinical Data
Participants for this study were recruited through 5 different centers located in Brisbane, Sydney, and Melbourne, Australia; St. Louis, MO; and Innsbruck, Austria. The study protocol was approved by the relevant ethics committees at each of the institutions. Some patients subsequently were treated and only pre-intervention biopsy specimens were used for this study. Some of the patients from Melbourne, St. Louis, and Innsbruck were included in earlier intervention studies describing the effects
Clinical and Histologic Data
The clinical and histologic data are summarized in Table 1. Of a total of 107 subjects, 51 were male and the mean age was 44 years. The body mass index, fasting serum insulin level, fasting serum glucose level, HOMA-IR score, and alanine aminotransferase level were available for 93, 82, 89, 79, and 75 patients, respectively. The mean body mass index was in the obese range at 38.2 kg/m2, and the mean HOMA-IR score was 6.9. Sixty-nine subjects (65%) had NASH, 22 had simple steatosis (21%), and 16
Discussion
There is significant interest in the natural history and prognosis of NAFLD. Progressive disease largely is limited to the subgroup of patients with NASH. Initially characterized by subsinusoidal fibrosis in zone 3, with increasing severity the fibrosis develops in portal/periportal areas, progressing to fibrous linkage and cirrhosis in advanced cases. The presence of portal fibrosis is an important feature in the published NASH staging systems.1, 2
An association between the expansion of HPCs
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Supported by the National Health and Medical Research Council, the Queensland Government’s Smart State Health and Medical Research Fund, the Princess Alexandra Hospital Research and Development Foundation, the Royal Children’s Hospital Foundation, and the Sasakawa Foundation.