Liver, Pancreas, and Biliary TractIncreased hepatic iron concentration in nonalcoholic steatohepatitis is associated with increased fibrosis☆,☆☆,★
Section snippets
Patients
Fifty-one patients in whom NASH was diagnosed were studied. The diagnosis of NASH was made on the basis of the presence of predominantly macrovesicular steatosis with lobular inflammation. The presence of Mallory's bodies and hepatic fibrosis was not considered essential for the diagnosis. No patient had a family history of hemochromatosis, and no patient was diagnosed or treated as having hemochromatosis after initial investigation and liver biopsy, because no patient fitted the accepted
General characteristic of the cohort of NASH patients studied
The main laboratory and histological features of the 51 patients with NASH studied are summarized in Table 1. The HIC of the patients with NASH ranged from 1 to 81 mmol/g dry wt. The men with NASH (51%) tended to be younger and have higher hepatic iron stores than the women. For this reason, results in Table 1 are presented for each sex. In this group of patients with NASH, in support of our clinical impression, 62% (26 of 42) had serum ferritin levels of >300 mmol/L, whereas only 22% (9 of 41)
Discussion
Most previous publications on NASH have not commented on iron stores in the liver. This study has confirmed that many patients with NASH have elevated serum ferritin levels at presentation (62%), although their TS results are usually normal. It also demonstrates that most patients with NASH with stainable hepatic iron stores have 1 or 2 copies of the Cys282Tyr mutation. Furthermore, increased hepatic iron stores may be a major determinant of fibrosis in patients with NASH.
The recognition of
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Supported by a Program Grant from the National Health and Medical Research Council of Australia. Graeme A. Macdonald is a National Health and Medical Research Council of Australia Medical Postgraduate Scholar. Elizabeth C. Jazwinska is a Senior Research Fellow of the Gastroenterological Society of Australia.
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Address requests for reprints to: Lawrie W. Powell, M.D., Ph.D., Queensland Institute of Medical Research, The Bancroft Centre, P.O. Royal Brisbane Hospital, Brisbane, Queensland, Australia 4029.
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Drs. George and Goldwurm contributed equally to this work.