Comparison of the severity of non-alcoholic fatty liver disease in diabetic and non-diabetic obese patients.

INTRODUCTION: nonalcoholic fatty liver disease presents a broad spectrum of histopathological alterations, from steatosis to liver cirrhosis. Patients with diabetes mellitus (DM) present increased incidence and severity of NAFLD. OBJECTIVE: determine the prevalence and severity of NAFLD in diabetic and non-diabetic obese patients undergoing bariatric surgery. METHOD: the evaluation of liver biopsies was carried out through NAFLD activity score (NAS) in order to evaluate degree of hepatic steatosis, presence of ballooning, inflammatory activity and degree of fibrosis. RESULTS: a total of 154 patients who have undergone bariatric surgery with intraoperative biopsy were observed and divided into two BMI ranges: from 35 to 44.9 and from 45 to 54.9. 32 (20.8%) from 154 patients were diabetic and 122 (79.2%) were non-diabetic. Patients with DM were significantly older than patients without the disease, presenting 41.29 ± 9.40 years vs 36.71 ± 10.13 years in the group with BMI of 35 to 44.9 (p=0.049); and 45.13 ± 7.10 years vs 37.00 ± 9.24 years in the group with BMI of 45 to 54.9 (p=0.024). In the histological evaluation, patients with DM from the BMI group of 35 to 44.9 had a strong association with higher prevalence and severity of steatosis, balloning, inflammation, fibrosis and steatohepatitis. CONCLUSION: the present study confirms the high prevalence of NAFLD in patients with Morbid Obesity. Prevalence and severity increase proportionally to BMI and who have DM as comorbidity.

Comparison of the severity of non-alcoholic fatty liver disease in diabetic and non-diabetic obese patients / Comparação da gravidade da doença hepática gordurosa não alcoólica de pacientes obesos diabéticos e não diabéticos

ABSTRACT Introduction: nonalcoholic fatty liver disease presents a broad spectrum of histopathological alterations, from steatosis to liver cirrhosis. Patients with diabetes mellitus (DM) present increased incidence and severity of NAFLD. Objective: determine the prevalence and severity of NAFLD in diabetic and non-diabetic obese patients undergoing bariatric surgery. Method: the evaluation of liver biopsies was carried out through NAFLD activity score (NAS) in order to evaluate degree of hepatic steatosis, presence of ballooning, inflammatory activity and degree of fibrosis. Results: a total of 154 patients who have undergone bariatric surgery with intraoperative biopsy were observed and divided into two BMI ranges: from 35 to 44.9 and from 45 to 54.9. 32 (20.8%) from 154 patients were diabetic and 122 (79.2%) were non-diabetic. Patients with DM were significantly older than patients without the disease, presenting 41.29 ± 9.40 years vs 36.71 ± 10.13 years in the group with BMI of 35 to 44.9 (p=0.049); and 45.13 ± 7.10 years vs 37.00 ± 9.24 years in the group with BMI of 45 to 54.9 (p=0.024). In the histological evaluation, patients with DM from the BMI group of 35 to 44.9 had a strong association with higher prevalence and severity of steatosis, balloning, inflammation, fibrosis and steatohepatitis. Conclusion: the present study confirms the high prevalence of NAFLD in patients with Morbid Obesity. Prevalence and severity increase proportionally to BMI and who have DM as comorbidity.

RESUMO Introdução: a doença hepática gordurosa não alcoólica apresenta um amplo espectro de alterações histopatológicas, desde a esteatose até a cirrose hepática. Pacientes com diabetes Mellitus (DMT2) têm risco aumentado para incidência e gravidade dessa doença. Objetivo: determinar a prevalência e a gravidade da DHGNA em pacientes obesos diabéticos e não diabéticos submetidos à cirurgia bariátrica. Pacientes e Métodos: avaliação das biópsias hepáticas através do NAFLD activity score (NAS) para avaliação quanto ao grau de esteatose hepática, à presença de balonização, à atividade da inflamação e ao grau de fibrose. Resultados: foram observados 154 pacientes submetidos à cirurgia bariátrica com biópsia transoperatória concomitante, divididos em duas faixas de IMC, de 35 a 44.9kg/m² e de 45 a 54.9kg/m². Dos 154 pacientes, 32 (20,8%) eram diabéticos e 122 (79,2%) eram não diabéticos. Os pacientes com DMT2 eram significativamente mais velhos, 41,29 ± 9,40 anos vs 36,71±10,13 anos, no grupo com IMC de 35 a 44.9kg/m² (p=0,049) e 45,13 ± 7,10 anos vs 37,00 ± 9,24 anos no grupo com IMC de 45 a 54.9kg/m² (p=0,024). Na avaliação histológica realizada, os pacientes com DMT2 do grupo com IMC de 35 a 44.9 apresentaram forte associação com maior prevalência e gravidade de estetose, balonização, inflamação, fibrose e esteato-hepatite. Conclusão: os dados deste estudo confirmam prevalência elevada de DHGNA em pacientes com obesidade mórbida. A prevalência e a gravidade aumentam proporcionalmente ao IMC e com a presença de DMT2.

Evaluation of the C3435T polymorphism in the MDR1 gene in patients with hepatocellular carcinoma.

INTRODUCTION: Considering the high prevalence of liver tumors and the impact on patient survival, a greater understanding of the biological behavior of those tumors if of great importance. The multidrug resistance gene (MDR1) may present as single nucleotide polymorphism (SNP) which can affect the expression and activity of P-glycoprotein (Pgp), and high expression of Pgp has been associated with a worse prognosis in affected patients. OBJECTIVE: To correlate the C3435T polymorphism in the MDR1 gene with the immunohistochemical expression of Pgp. MATERIAL AND METHODS: A total of 67 samples from patients with diagnosis of hepatocellular carcinoma (HCC), collected in the period from 2000 to 2009, were analyzed. The polymorphism in the MDR1 gene was determined by the technique of allele-specific real time PCR using TaqMan assay, and the expression of protein Pgp was evaluated by immunohistochemistry. RESULTS: Among the samples evaluated, 56 (83.6%) were from male patients and 11 (16.4%) from females. Mean age was 60.6 years (± 8.8), ranging from 37 to 85 years. The etiology of the HCC was related to hepatitis C virus infection (HCV) in 31 (46.3%) of cases, followed by hepatitis C virus infection + alcohol in 24 cases (35.8%), alcohol in 4 cases (6)%, hepatitis B virus (HBV) in 4 cases (6%) and other factors in 4 cases (6%). Liver transplantation was performed in 48 cases (71.6%) and hepatectomia in 19 cases (28.4%). The genotypes CC, CT and TT showed frequencies of 25.4%, 41.8% and 32.8%, respectively, and the allele frequencies were 46.3% for allele C and 53.7% for allele T. The expression of Pgp in over 75% of the cells was significantly more frequent in tumor tissue. On the other hand, a low expression of Pgp, in less than 25% of the cells, was significantly more frequent in non-tumor tissue. The Pgp expression in more than 50% of tumor cells of individuals with genotypes CC, CT and TT was 15.7%, 51.0% and 33.3%, respectively, and was significantly higher when in the presence of allele T (p = 0.002). CONCLUSION: The presence of the polymorphic allele T is related to increased expression of Pgp protein in patients with HCC.