Clinical and histopathological features of NASH in workers exposed to chemicals with or without associated metabolic conditions.

OBJECTIVE

Non-alcoholic steatohepatitis (NASH) has been associated with exposure to chemicals among workers from an industrial complex in Brazil. We investigated the NASH profile of these individuals associated or not with metabolic conditions.

METHODS

Eighty-four patients with NASH were classified into three groups: G1, 31 patients exposed to chemicals (benzene, xylene, vinyl chloride and others); G2, 30 exposed patients who also presented with obesity, hyperlipidemia and diabetes; and G3, 23 non-exposed patients who presented with metabolic conditions.

RESULTS

G1 and G2 were similar in terms of gender (97% and 100% males) and age (37+/-5.4 and 39+/-6.5 years). In G3, 74% were males and the age was 48+/-3.4 years (P<0.05). In G2, obesity was present in 26.6%, hyperlipidemia in 66.6% and diabetes in 6.6%. In G3, obesity was observed in 43.4%, hyperlipidemia in 30.4% and diabetes in 26%. Macro- and microsteatosis were observed in 100% of cases. Perisinusoidal fibrosis was observed in 71% patients in G1, 80% in G2 and 52% in G3 (P<0.05). Histological evidence of cholestasis was present in 53% of cases in G1, 50% in G2 and 13% in G3 (P<0.05).

CONCLUSIONS

Exposure to chemicals appears to be an independent risk factor for NASH that presents a peculiar profile. It is more frequently seen in men younger than non-exposed ones. Steatosis, fibrosis and cholestasis were frequent histological findings. Co-existing metabolic factors did not seem to influence clinical or histopathological presentation.