Doença hepática gordurosa não alcoólica
patogênese e achados histológicos com ênfase nas alterações mitocondriais
Palavras-chave:
Doença hepática gordurosa não alcoólica, Fígado gorduroso, Mitocondriais hepática, HepatopatiaResumo
A esteatose hepática não relacionada ao alcoolismo pode ocorrer isoladamente ou como parte da doença hepática gordurosa não alcoólica, abrangendo amplo espectro de alterações morfológicas e variando de esteatose até estádios mais graves (acompanhados por fibrose), podendo chegar à cirrose. A esteatose hepática não relacionada ao alcoolismo tem grande importância clínica na atualidade não só por sua elevada prevalência (15% a 25% na população geral e superior a 80% entre obesos e diabéticos), mas também pela diversidade de condições relacionadas, tais como fatores nutricionais, hepatite pelo vírus C, doenças metabólicas, toxicidade por drogas etc. As alterações histológicas e a história natural da doença provavelmente reflitam um processo multifatorial complexo em que o ambiente genético tem grande importância uma vez que não se compreende porque alguns pacientes têm somente esteatose, enquanto outros desenvolvem esteato-hepatite, cirrose ou carcinoma hepatocelular. A fim de compreender melhor sua patogênese, vários são os artigos que correlacionam esteatose hepática a alterações mitocondriais (aumento do tamanho mitocondrial, da densidade, alterações na matriz e cristas e presença de megamitocôndrias com inclusões cristalinas), sendo a identificação precoce de formas de esteatose com conco mitante comprometimento mitocondrial de importância fundamental no prognóstico da doença. A esteatose microvesicular, na medida em que se relaciona a essas alterações, pode corresponder à lesão inicial do amplo espectro presente na esteatose hepática não relacionada ao alcoolismo, com uma pior evolução clínica.
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Referências
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