{"id":1759,"date":"2003-10-01T01:00:00","date_gmt":"2003-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/maladie-steatosique-non-alcoolique-du-foie-qui-faut-il-biopsier\/"},"modified":"2018-10-20T18:39:30","modified_gmt":"2018-10-20T16:39:30","slug":"maladie-steatosique-non-alcoolique-du-foie-qui-faut-il-biopsier","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/maladie-steatosique-non-alcoolique-du-foie-qui-faut-il-biopsier\/","title":{"rendered":"MALADIE STEATOSIQUE NON ALCOOLIQUE DU FOIE : QUI FAUT-IL BIOPSIER ?"},"content":{"rendered":"

2003<\/strong><\/p>\n

J. HENRION, A-S. LAMBERT, M-O. PENY, S. DE MAEGHT, P. DELTENRE, J-M. MAISIN, J-M. GHILAIN, M. SCHAPIRA<\/em><\/p>\n

H\u00e9patologie <\/strong>– \u00a02000-03-09 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

BUT DE L\u2019ETUDE : la maladie st\u00e9atosique non alcoolique du foie recouvre deux l\u00e9sions de pronostic tout \u00e0 fait diff\u00e9rent : la st\u00e9atose simple qui n\u2019a pas de potentiel \u00e9volutif vers la fibrose et la st\u00e9ato-h\u00e9patite non alcoolique (SHNA) qui a un risque de progression vers la cirrhose de l\u2019ordre de 20 % en 10 ans (1, 2). Le diagnostic diff\u00e9rentiel entre ces deux entit\u00e9s n\u2019est pas possible sur la base de param\u00e8tres cliniques et biologiques et donc, une biopsie h\u00e9patique est n\u00e9cessaire pour confirmer l\u2019existence d\u2019une SHNA. Il existe n\u00e9anmoins des facteurs pr\u00e9dictifs de fibrose en cas de NASH comme le degr\u00e9 d\u2019augmentation des ALAT, l\u2019\u00e2ge, le BMI, l\u2019hyperglyc\u00e9mie, l\u2019hypertriglyc\u00e9rid\u00e9mie et le degr\u00e9 de r\u00e9sistance \u00e0 l\u2019insuline. A partir de deux \u00e9tudes (3, 4) ayant \u00e9tudi\u00e9 les facteurs pr\u00e9dictifs de fibrose en cas de SHNA, nous avons d\u00e9fini des crit\u00e8res \u00e0 partir desquels nous proposons la ponction biopsie h\u00e9patique chez les malades atteints de maladie st\u00e9atosique non alcoolique du foie. Ces crit\u00e8res sont une augmentation des ALAT d\u2019au moins 2 fois la valeur sup\u00e9rieure de la normale dans les 6 mois pr\u00e9c\u00e9dents accompagn\u00e9e d\u2019au moins 2 des 4 param\u00e8tres suivants : \u00e2ge > 45 ans, BMI > 30 kg\/m\u00b2, glyc\u00e9mie \u00e0 jeun \u00b3 110 mg\/dl (ou diab\u00e8te trait\u00e9), triglyc\u00e9rid\u00e9mie \u00e0 jeun \u00b3 150 mg\/dl (ou hypertriglyc\u00e9rid\u00e9mie trait\u00e9e). Le but de cette \u00e9tude a \u00e9t\u00e9 de valider prospectivement ces crit\u00e8res de biopsie.
\nMALADES ET METHODES : du 01\/09\/2001 au 01\/12\/2002, les malades vus \u00e0 la consultation d\u2019h\u00e9patologie et nouvellement diagnostiqu\u00e9s comme porteurs d\u2019une maladie st\u00e9atosique non alcoolique du foie ont \u00e9t\u00e9 prospectivement collig\u00e9s. Le diagnostic de maladie st\u00e9atosique non alcoolique du foie reposait sur 4 crit\u00e8res : au moins un facteur de risque tel que surcharge pond\u00e9rale ou ob\u00e9sit\u00e9, diab\u00e8te ou hypertriglyc\u00e9rid\u00e9mie, des ALAT \u00e9lev\u00e9es, un aspect hyper\u00e9chog\u00e8ne du foie \u00e0 l\u2019\u00e9chotomographie et l\u2019exclusion d\u2019une autre cause de maladie h\u00e9patique. Les malades n\u2019ont pas \u00e9t\u00e9 inclus si la consommation quotidienne d\u2019alcool d\u00e9passait 20 g pour les femmes et 30 g pour les hommes. La biopsie h\u00e9patique \u00e9tait propos\u00e9e lorsque les crit\u00e8res d\u00e9finis plus haut \u00e9taient pr\u00e9sents. Le score de fibrose a \u00e9t\u00e9 appr\u00e9ci\u00e9 suivant la classification de Madame Elisabeth BRUNT (5), un score S1 correspondant \u00e0 une fibrose p\u00e9risinuso\u00efdale, un score S2 \u00e0 une fibrose portale avec peu de septa, un score S3 \u00e0 une fibrose diss\u00e9quante et un score S4 \u00e0 la cirrhose. La r\u00e9sistance \u00e0 l\u2019insuline a \u00e9t\u00e9 calcul\u00e9e par le test HOMA IR suivant la formule propos\u00e9e par Matthews et al (6) : insuline mU\/ml x glyc\u00e9mie mmol\/L \/ 22.5.
\nRESULTATS : 52 maladies furent recrut\u00e9s, 36 hommes et 16 femmes d\u2019\u00e2ge moyen de 48.7 ans (extr\u00eame 16-77). Le BMI moyen \u00e9tait de 31.2 kg\/m\u00b2 (extr\u00eame 24-44). Vingt et un malades (40 %) avaient soit une intol\u00e9rance aux hydrates de carbone, soit un diab\u00e8te. Chez 9 d\u2019entre eux, le d\u00e9s\u00e9quilibre glyc\u00e9mique \u00e9tait inconnu. Quarante-cinq malades (86.5 %) avaient une hypertriglyc\u00e9rid\u00e9mie, ignor\u00e9e chez 19 d\u2019entre eux. Une hypertension art\u00e9rielle connue et trait\u00e9e \u00e9tait retrouv\u00e9e chez 18 malades (34.5 %). Le motif de la consultation \u00e9tait une augmentation des transaminases chez 48 malades et une hyperferritin\u00e9mie chez 4 malades.
\nEn concordance avec les crit\u00e8res d\u00e9finis plus haut, la biopsie h\u00e9patique a \u00e9t\u00e9 propos\u00e9e \u00e0 30 malades et r\u00e9alis\u00e9e chez 24 d\u2019entre eux. Les scores de fibrose et les donn\u00e9es pertinentes en relation avec ces scores de fibrose sont rapport\u00e9s dans le tableau.<\/p>\n

BIOPSIE HEPATIQUE : 24 malades<\/p>\n

S0 – S1<\/p>\n

S2 \u2013 S4<\/p>\n

N = 9
\np
\nN = 15
\nGenre M\/F
\nAge
\nBMI
\nHyperglyc\u00e9mie
\nHypertrigly.
\nHypert. art\u00e9rielle
\nInsuline (\u00b5u\/ml)
\nHOMA IR
\n6\/3
\n45
\n32.6
\n3 (33 %)
\n9 (100 %)
\n3 (33 %)
\n16
\n4.4<\/p>\n

< 0.01
\n< 0.01
\n11\/4
\n51.5
\n32.9
\n8\/15 (53 %)
\n15 (100 %)
\n4 (26 %)
\n32.3
\n9.3<\/p>\n

CONCLUSIONS : \u00e0 la consultation d\u2019h\u00e9patologie de notre h\u00f4pital, les malades vus pour une maladie st\u00e9atosique non alcoolique du foie sont essentiellement des hommes d\u2019\u00e2ge moyen ayant une ob\u00e9sit\u00e9 mod\u00e9r\u00e9e et une hypertriglyc\u00e9rid\u00e9mie. Les crit\u00e8res de biopsie propos\u00e9s semblent valid\u00e9s puisque 15\/24 biopsies h\u00e9patiques (62.5 %) montraient une fibrose substantielle de score au moins S2. Parmi les facteurs pr\u00e9dictifs de fibrose en cas de maladie st\u00e9atosique non alcoolique du foie, l\u2019insulin\u00e9mie \u00e0 jeun et le test HOMA IR semblent \u00eatre prometteurs.<\/p>\n

REFERENCES : 1\/ MATTEONI et al. Gastroenterology 1999 ; 116 : 1413-19 ; 2\/ YOUNOSSI et al. Hepatology 2002 ; 35 : 746-752 ; 3\/ ANGULO et al. Hepatology 1999 ; 30 : 1356-1362 ; 4\/ RATZIU et al. Gastroenterology 2000 ; 118 : 1117-1123 ; 5\/ BRUNT et al. Am J Gastroenterol 1999 ; 94 : 2467-2474 ; 6\/ MATTHEWS et al. Diabetologia 1985 ; 28 : 412-419<\/p>\n","protected":false},"excerpt":{"rendered":"

2003 J. HENRION, A-S. LAMBERT, M-O. PENY, S. DE MAEGHT, P. DELTENRE, J-M. MAISIN, J-M. GHILAIN, M. SCHAPIRA H\u00e9patologie – \u00a02000-03-09 –\u00a0CO – ________________________________ BUT DE L\u2019ETUDE : la maladie st\u00e9atosique non alcoolique du foie recouvre deux l\u00e9sions de pronostic tout \u00e0 fait diff\u00e9rent : la st\u00e9atose simple qui n\u2019a pas de potentiel \u00e9volutif vers […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[3],"tags":[14],"class_list":["post-1759","post","type-post","status-publish","format-standard","hentry","category-hepatologie","tag-14"],"yoast_head":"\nMALADIE STEATOSIQUE NON ALCOOLIQUE DU FOIE : QUI FAUT-IL BIOPSIER ? - Abstracts des congr\u00e8s de l'ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/maladie-steatosique-non-alcoolique-du-foie-qui-faut-il-biopsier\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"MALADIE STEATOSIQUE NON ALCOOLIQUE DU FOIE : QUI FAUT-IL BIOPSIER ? 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