Non-alcoholic steatohepatitis and influence of age and gender on histopathologic findings

Table 1 Histopathologic grading (Brunt)[18] of different finding in liver biopsies of non-alcoholic steatohepatitis patients

Finding	Grading
Hepatosteatosis
Grade I	< 33% of hepatocytes affected
Grade II	33%-66% of hepatocytes affected
Grade III	> 66% of hepatocytes affected
Fibrosis
No fibrosis	No fibrosis
Grade I	Zone 3 perisinusoidal pericellular fibrosis, focally or extensively present
Grade II	Zone 3 perisinusoidal pericellular fibrosis, with focal or extensive periportal fibrosis
Grade III	Zone 3 perisinusoidal pericellular fibrosis and portal fibrosis with extensive or focal bridging fibrosis
Cirrhosis	Cirrhosis
Hepatocyte ballooning
No ballooning	No ballooning
Grade I	Sometimes, zone 3
Grade II	Evident, zone 3
Grade III	Symptomatic, more dominant in zone 3
Lobar inflamation
No change	No change
Grade I	Diffuse neutrophils, monocytes at 1 or 2 points in a 20 × microscopic field
Grade II	PMN with ballooning hepatocytes, chronic inflammation at 2 to 4 points in a 20 × microscopic field
Portal inflamation
No change	No change
Grade I	Mild, some portal areas
Grade II	Mild to moderate, most portal areas
Grade III	Moderate to severe, most portal areas

PMN: Polymorphonuclear leukocyte.

Table 2 Baseline and clinical characteristics of non-alcoholic steatohepatitis patients regarding different sex and age groups (mean ± SD)

Variable	Total (n = 77)	Sex groups		P-value	Age groups		P-value
		Male (n = 58)	Female (n = 19)		< 55 yr (n = 65)	≥ 55 yr (n = 12)
Age (yr)	41.99 ± 11.80	39.74 ± 10.16	48.72 ± 13.99	0.004a	-	-	-
Gender, n (%)
Female	19 (24.7)	-	-	-	14 (21.5)	5 (41.6)	0.214
Male	58 (75.3)				51 (78.5)	7 (58.4)
BMI (kg/m2)	28.62 ± 3.42	28.86 ± 3.25	27.81 ± 4.00	0.336	28.74 ± 3.55	26.87 ± 2.52	0.186
Fasting blood sugar (mg/dL)	107.37 ± 47.60	103.16 ± 47.39	121.14 ± 47.14	0.195	107.88 ± 52.06	114.12 ± 25.85	0.742
Total cholesterol (mg/dL)	197.29 ± 47.81	192.07 ± 45.52	212.68 ± 52.26	0.105	197.07 ± 46.98	200.67 ± 37.82	0.827
Triglyceride (mg/dL)	202.26 ± 118.13	201.72 ± 97.26	203.89 ± 169.65	0.947	206.40 ± 121.92	202.33 ± 100.36	0.876
LDL-cholesterol (mg/dL)	119.09 ± 39.20	119.87 ± 35.00	117.13 ± 49.64	0.822	118.27 ± 38.74	134.43 ± 40.13	0.313
HDL-cholesterol (mg/dL)	46.61 ± 24.53	44.97 ± 25.20	50.87 ± 22.97	0.301	47.86 ± 26.45	40.12 ± 13.68	0.891
PTT (s)	12.47 ± 1.50	12.39 ± 1.66	12.72 ± 0.86	0.846	12.45 ± 1.58	12.40 ± 1.52	0.842
Platelet count (/L)	358 505 ± 48 852	357 505 ± 52 403	361 125 ± 39 954	0.122	395 325 ± 55 385	237 385 ± 63 753	0.964
ALT (U/L)	117.73 ± 237.52	92.05 ± 60.72	196.11 ± 466.82	0.943	123.21 ± 260.49	100.44 ± 91.57	0.772
AST (U/L)	58.29 ± 27.77	52.78 ± 25.00	75.11 ± 29.68	0.002a	57.28 ± 28.17	57.89 ± 20.52	0.951
Alk-P (U/L)	176.48 ± 96.95	171.14 ± 92.19	192.21 ± 111.00	0.417	176.11 ± 94.50	183.44 ± 128.40	0.837
γ-GTP (U/L)	29.55 ± 28.40	28.69 ± 30.95	31.42 ± 24.47	0.852	28.74 ± 3.55	15.17 ± 3.76	0.333

^aStatistically significant. BMI: Body mass index; LDL: Low density lipoprotein; HDL: High density lipoprotein; PTT: Partial thromboplastin time; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; Alk-P: Alkaline phosphatase; γ-GTP: γ-glutamyl transpeptidase.

Table 3 Histopathologic characteristics of non-alcoholic steatohepatitis patients regarding different sex and age groups (mean ± SD) n (%)

Finding	Total (n = 77)	Sex groups		P-value	Age groups		P-value
		Male (n = 58)	Female (n = 19)		< 55 yr (n = 65)	≥ 55 yr (n = 12)
Hepatosteatosis
Grade I	36 (46.8)	30 (51.7)	6 (31.6)		34 (54)	1 (11.2)
Grade II	29 (37.7)	22 (37.9)	7 (36.8)	0.068	23 (36.5)	4 (44.4)	0.007a
Grade III	12 (15.6)	6 (10.3)	6 (31.6)		6 (9.5)	4 (44.4)
Mean grade	1.69 ± 0.73	1.59 ± 0.68	2.00 ± 0.82	0.031a	1.56 ± 0.67	2.33 ± 0.71	0.002a
Fibrosis
No fibrosis	31 (41.3)	24 (42.1)	7 (38.9)		27 (44.3)	2 (22.2)
Grade I	29 (38.7)	24 (42.1)	5 (27.8)		22 (36.1)	4 (44.4)
Grade II	7 (9.3)	4 (7)	3 (16.7)	0.563	6 (9.8)	1 (11.1)	0.307
Grade III	3 (4)	2 (3.5)	1 (5.6)		3 (4.9)	-
Cirrhosis	5 (6.7)	3 (5.3)	2 (11.1)		3 (4.9)	2 (22.2)
Mean grade	0.96 ± 1.13	0.88 ± 1.05	1.22 ± 1.35	0.263	0.91 ± 1.09	1.56 ± 1.51	0.115
Hepatocyte ballooning
No ballooning	52 (72.2)	41 (74.5)	11 (64.7)		42 (71.2)	6 (75)
Grade I	12 (16.7)	8 (14.5)	4 (23.5)	0.224	11 (18.6)	1 (12.5)	0.935
Grade II	7 (9.7)	6 (10.9)	1 (5.9)		5 (8.5)	1 (12.5)
Grade III	1 (1.4)	-	1 (5.9)		1 (1.7)	-
Mean grade	0.40 ± 0.72	0.36 ± 0.68	0.53 ± 0.87	0.448	0.41 ± 0.72	0.37 ± 0.74	0.864
Lobar inflammation
No change	25 (36.8)	23 (42.6)	2 (14.3)		18 (31.6)	6 (100)
Grade I	37 (54.4)	27 (50)	10 (71.4)	0.138	34 (59.6)	-	0.005a
Grade II	6 (8.8)	4 (7.4)	2 (14.3)		5 (8.8)	-
Mean grade	0.72 ± 0.62	0.65 ± 0.62	1.00 ± 0.55	0.052	0.77 ± 0.60	-	0.004a
Portal inflammation
No change	41 (55.3)	33 (58.9)	8 (44.4)		35 (58.3)	3 (33.3)
Grade I	25 (33.8)	19 (33.9)	6 (33.3)		19 (31.7)	5 (55.6)	0.045a
Grade II	6 (8.1)	3 (5.4)	3 (16.7)	0.192	5 (8.3)	-
Grade III	2 (2.8)	1 (1.8)	1 (5.6)		1 (1.7)	1 (11.1)
Mean grade	0.59 ± 0.81	0.52 ± 0.76	0.83 ± 0.92	0.163	0.55 ± 0.79	0.89 ± 0.93	0.200

^aStatistically significant.