Estudo histopatológico da esteatose na hepatite crônica pelo vírus C

Abstract

The hepatitis C virus (HCV) and steatosis are important causes of chronic hepatic disease in the world. Although common, the pathofisiology of steatosis and its role in the progression of fibrosis in patients with HCV is uncertain. Our objective was to quantify the macrovacuolar and microvesicular steatosis and to correlate them with clinical and histophatologic data. The study included needle biopsy of the liver of patients with HCV without previous treatment. The fibrosis and necroinflammatory activity of hepatic damage by HCV were evaluated by METAVIR and Ishak’s scores; Kleiner’s and Brunt’s classification were used as a support for diagnosis of the steatohepatitis by the pathologist. Furthermore, the number of hepatocytes with the macrovacuolar and microvesicular steatosis was quantified in a total number of hepatocytes. Fibrosis and necroinflammatory activity were categorized and semi quantified. A significant association of the fibrosis was found and it was evaluated by the Ishak system between the macrogoticular and the microgoticular steatosis (p=0,017 e p= 0,0113, respectively). The global inflammatory activity (Metavir classification) has presented a linear correlation with the worsening of the fibrosis (< 0,001). The fibrosis which was evaluated by the Metavir system has been correlated with the BMI. The presence of HCV associated with the steatohepatitis has presented a significant correlation with the average of AST/ALT and with the Ishak and Metavir fibrosis, when compared to the data of the patients with HCV, without steatohepatitis (p= 0,006; p= 0,012; p= 0,0098 and p= 0,014, respectively) In our research we conclude that the Ishak fibrosis has been associated with the macrogoticular and microgoticular steatosis. Equally, it was demonstrated that the presence of the steatohepatitis was strongly associated to the fibrosis.