Histopathologische Diagnose der nicht alkoholischen und alkoholischen Fettlebererkrankung

Zusammenfassung

Eine alkoholische (AFL) und eine nicht alkoholische 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 mit hepatozytärer Ballonierung führt zur alkoholischen (ASH) oder nicht alkoholischen (NASH) Steatohepatitis. Eine ASH bzw. NASH kann zur Fibrose oder Zirrhose führen. In der klinischen Praxis ist es bislang allein auf Basis nicht invasiver Tests nicht möglich, zwischen Steatose und Steatohepatitis zu unterscheiden. Eine Steatohepatitis liegt dann vor, wenn neben der Steatose gemischtzellige entzündliche Infiltrate in den Leberläppchen nachweisbar sind und zusätzlich eine Leberzellschädigung in Form einer Ballonierung vorliegt. Die Leberbiopsie ist der „Goldstandard” bei der Sicherung der Diagnose sowie der Bestimmung der entzündlichen Aktivität und möglichen Fibrose einer Fettlebererkrankung. Die Indikation zur Biopsie sollte den möglichen Informationsgewinn durch die Biopsie und seine Konsequenzen im Vergleich zu Aufwand und Komplikationsrate berücksichtigen und daher im klinischen Kontext gestellt werden.

Abstract

Alcoholic fatty liver (AFL) as well as non-alcoholic fatty liver (NAFL) are characterised by deposition of lipids into hepatocytes. The diagnosis of steatosis is made if lipid deposition exceeds 5 % of hepatocytes, in case of more than 50 % it is called ”fatty liver”. An additional inflammatory reaction, with ballooning of hepatocytes, leads to alcoholic steatohepatitis (ASH) or non-alcoholic steatohepatitis (NASH). Both ASH or NASH may lead to fibrosis or cirrhosis. To date in clinical practice it is not possible to differentiate between steatosis and steatohepatitis just on the basis of non-invasive tests. Steatohepatitis is present if, along with steatosis, both inflammatory infiltrates of mixed cells in the small liver lobules and liver cell injury in terms of ballooning can be detected. Liver biopsy represents the ”gold standard” for confirming the diagnosis and to determine inflammatory activity and potential fibrosis of fatty liver disease. Indications for biopsy should take into account the possible information and its consequences as compared to expense and complication rate and therefore should be assessed in the clinical context.

Schlüsselwörter

nicht alkoholische Steatohepatitis - alkoholische Steatohepatitis - Chemotherapie - kindliche NASH - Ballonierung - Fibrose - Zirrhose - Differenzialdiagnose - Scoring - Leberbiopsie

Key words

non-alcoholic steatohepatitis - alcoholic steatohepatitis - chemotherapy - NASH in children - ballooning - fibrosis - cirrhosis - differential diagnosis - scoring - liver biopsy

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