摘要: Resumen La teoria del «doble impacto» es la mas aceptada para explicar patogenia de esteatohepatitis no alcoholica y resistencia a insulina un factor clave. En el «primer impacto » mayor aflujo acidos grasos al hepatocito, combinado con una eliminacion disminuida trigliceridos menor oxidacion grasos, condiciona esteatosis. Esta siempre quiescente, pues los acumulados son susceptibles «segundo impacto», en que intervendrian: a) estres oxidativo, aumento produccion radicales libres oxigeno activan factores transcripcion como nuclear kappa-beta, lo cual facilita formacion citocinas (factor necrosis tumoral alfa, crecimiento beta 1, interleucina 8 ligandos Fas; b) peroxidacion lipidica malondialdehido 4-hidroxinonenal, promueven celulas inflamatorias higado, deplecionan antioxidants tipo glutation, inducen cuerpos Mallory e incrementan sintesis colagena activar las estrelladas, c) leptina, endotoxinas sobrecarga hierro, conjuntamente lesiones esteatohepatitis.
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