Anty Rodolphe, Bekri Soumeya, Luciani Nathalie, Saint-Paul Marie-Christine, Dahman Moncef, Iannelli Antonio, Amor Imed Ben, Staccini-Myx Aline, Huet Pierre-Michel, Gugenheim Jean, Sadoul Jean-Louis, Le Marchand-Brustel Yannick, Tran Albert, Gual Philippe
INSERM U 568, Nice, France.
Am J Gastroenterol. 2006 Aug;101(8):1824-33. doi: 10.1111/j.1572-0241.2006.00724.x. Epub 2006 Jun 22.
C-Reactive Protein (CRP), a nonspecific marker of inflammation that is moderately elevated in obesity, metabolic syndrome (MS), and type 2 diabetes, has been proposed as a surrogate marker of nonalcoholic steatohepatitis (NASH). Its clinical usefulness in the diagnosis of NASH was evaluated in severely obese patients without or with MS, diabetes, and NASH and the potential roles of the liver and of the adipose tissue in CRP production were characterized.
Severely obese patients without NASH (without MS [N = 13], with MS [N = 11], or with MS and diabetes [N = 7]) and with NASH (without [N = 8] or with [N = 7] MS) were studied. For each patient, liver and adipose tissue biopsies were collected during a bariatric surgery and were used to determine the CRP gene expression by real-time PCR. The role of interleukin-6 (IL6) and lipopolysaccharide in CRP expression was also evaluated in subcutaneous adipose tissue obtained during cosmetic abdominoplasty.
Plasma CRP levels were elevated in severely obese patients independently from the presence or absence of MS, diabetes, or NASH. CRP gene expression was not only increased in livers but also in adipose tissues of obese patients compared with controls subjects. In human adipose tissue, CRP mRNA levels were positively correlated with those of IL-6 and the CRP expression was enhanced in vitro by IL-6 and lipopolysaccharide.
Plasma CRP levels are not predictive of the diagnosis of NASH in severely obese patients. The liver but also the adipose tissue can produce CRP, a process which could be dependent on IL6. Therefore, both tissues might contribute to the elevated plasma CRP levels found in obesity. In addition, the large amount of body fat may well produce an important part of the circulating CRP, further limiting its clinical usefulness in the evaluation of NASH in severely obese patients.
C反应蛋白（CRP）是一种炎症非特异性标志物，在肥胖、代谢综合征（MS）和2型糖尿病中会适度升高，已被提议作为非酒精性脂肪性肝炎（NASH）的替代标志物。在无或患有MS、糖尿病和NASH的严重肥胖患者中评估了其在NASH诊断中的临床实用性，并对肝脏和脂肪组织在CRP产生中的潜在作用进行了表征。
研究了无NASH（无MS [N = 13]、有MS [N = 11]或有MS和糖尿病 [N = 7]）以及有NASH（无 [N = 8]或有 [N = 7] MS）的严重肥胖患者。对于每位患者，在减肥手术期间采集肝脏和脂肪组织活检样本，并通过实时PCR测定CRP基因表达。还在美容腹部整形手术期间获得的皮下脂肪组织中评估了白细胞介素-6（IL6）和脂多糖在CRP表达中的作用。
严重肥胖患者的血浆CRP水平升高，与是否存在MS、糖尿病或NASH无关。与对照受试者相比，肥胖患者不仅肝脏中的CRP基因表达增加，脂肪组织中的也增加。在人体脂肪组织中，CRP mRNA水平与IL-6的水平呈正相关，并且IL-6和脂多糖在体外增强了CRP表达。
血浆CRP水平不能预测严重肥胖患者的NASH诊断。肝脏和脂肪组织均可产生CRP，这一过程可能依赖于IL6。因此，这两种组织可能都导致了肥胖患者血浆CRP水平升高。此外，大量体脂很可能产生了循环CRP的重要部分，进一步限制了其在评估严重肥胖患者NASH中的临床实用性。
