是的 CD14 upregulation 在 pancreatoduodenectomy 以后的非酒精的脂肪肝疾病的一个不同特征

AIM:To investigate the pathogenesis of non-alcoholic fatty liver disease(NAFLD)after pancreatoduodenectomy(PD).METHODS:A cohort of 82 patients who underwent PD at Okayama University Hospital between 2003 and 2009 was enrolled and the clinicopathological features were compared between patients with and without NAFLD after PD.Computed tomography(CT)images were evaluated every 6 mo after PD for follow-up.Hepatic steatosis was diagnosed on CT when hepatic attenuation values were 40 Hounsfield units.Liver biopsy was performed for 4 of 30 patients with NAFLD after PD who consented to undergo biopsies.To compare NAFLD after PD with NAFLD associated with metabolic syndrome,liver samples were obtained from 10 patients with NAFLD associated with metabolic syndrome [fatty liver,n = 5;non-alcoholic steatohepatitis(NASH),n = 5] by percutaneous ultrasonography-guided liver biopsy.Double-fluorescence immunohistochemistry was applied to examine CD14 expression as a marker of lipopolysaccharide(LPS)-sensitized macrophage cells(Kupffer cells)in liver biopsy specimens.RESULTS:The incidence of postoperative NAFLD was 36.6%(30/82).Univariate analysis identified cancer of the pancreatic head,sex,diameter of the main pancreatic duct,and dissection of the nerve plexus as factors associated with the development of NAFLD after PD.Those patients who developed NAFLD after PD demonstrated significantly decreased levels of serum albumin,total protein,cholesterol and triglycerides compared to patients without NAFLD after PD,but no glucose intolerance or insulin resistance.Liver biopsy was performed in four patients with NAFLD after PD.All four patients showed moderate-to-severe steatosis and NASH was diagnosed in two.Numbers of cells positive for CD68(a marker of Kupffer cells)and CD14(a marker of LPSsensitized Kupffer cells)were counted in all biopsy specimens.The number of CD68+ cells in specimens of NAFLD after PD was significantly increased from that in specimens of NAFLD associated with metabolic syndrome specimens,which indicated the pr