Rodríguez-Leal Gustavo Arturo, Morán Segundo, Gallardo Irazu, Milke Pilar, Guevara-González Luis
Clínica de Gastroenterología, Hospital Medica Sur, México, DF.
Rev Gastroenterol Mex. 2006 Jan-Mar;71(1):39-45.
C-reactive protein (CRP) plays an important role on inflammatory processes associated to the metabolic syndrome (MS), alike of insulin sensitivity, endothelial dysfunction and fibrinolysis insufficiency. Alanine aminotransferase (ALT) may be a sensible marker for the diagnosis of hepatic damage and has therefore been used as an alternative method for the noninvasive diagnosis of non-alcoholic fatty liver disease (NAFLD), especially in epidemiological studies. At the present time, the possible utility of high sensitivity CRP (hsCRP) as a simple measure to detect the degree of hepatic inflammatory response during the development NAFLD in MS has not been explored.
To evaluate the measurement of serologic hsCRP for the identification of hepatic inflammatory response in patients with MS.
Seven hundred and forty persons (526 men and 214 women), mean age 45 +/- 11 years who were asymptomatic and otherwise seeming healthy in whom a medical questionnaire was applied underwent physical examination, laboratory testing, hepatic ultrasound and measurement of hsCRP by the immuno-turbidimetric method. Receiver operating characteristic (ROC) analysis was used to evaluate the sensitivity and specificity of all possible hsCRP for detecting different degrees of hepatic inflammation (ALT > 44 U/L and ALT > 88 U/L). Patients were stratified according to the presence of metabolic syndrome (MS) and ALT concentration in three groups: Group I, having MS and ALT > 44 U/L (n = 39); Group II, having ALT > 44 U/L without MS (n = 105) and Group III, having ALT < or = 44 U/L without MS (n = 596).
The optimal hsCRP cut-off for detecting patients with ALT 44 U/L was 2.5 mg/L (sensibility 66%; specificity 50%) and for detecting patients with ALT > 88 U/L was 2.35 (sensibility 72%; specificity 59%). hsCRP serum concentrations in Group I were significantly higher than in Group II and Group III (p < 0.05) but no difference was found between Group II and Group III (Group I = 6.0 +/- 6.7 mg/L vs. Group II = 2.8 +/- 3.1 mg/L, vs. Group III = 2.9 +/- 4.1 mg/L). ALT concentrations were also significantly higher in Group I than in Group II and Group III, (p < 0.05) and a difference between Group II and Group III (p < 0.05) was also found (Group I = 72 +/- 31 U/L vs. Group II = 64 +/- 29 U/L vs. Group III = 24 +/- 8 U/L).
These results suggest that the measurement of hsCRP for the identification of hepatic inflammatory response in patients with MS with NAFLD is limited because of its low sensibility and specificity observed on identifying different degrees of hepatic inflammation.
C反应蛋白（CRP）在与代谢综合征（MS）相关的炎症过程中发挥重要作用，这些炎症过程包括胰岛素敏感性、内皮功能障碍和纤溶不足。丙氨酸氨基转移酶（ALT）可能是诊断肝损伤的一个敏感指标，因此已被用作非酒精性脂肪性肝病（NAFLD）无创诊断的替代方法，尤其是在流行病学研究中。目前，尚未探讨高敏CRP（hsCRP）作为一种简单方法检测MS患者发生NAFLD过程中肝脏炎症反应程度的潜在用途。
评估血清hsCRP检测在MS患者中识别肝脏炎症反应的价值。
740名（526名男性和214名女性）平均年龄45±11岁、无症状且看似健康的受试者接受了医学问卷调查、体格检查、实验室检测、肝脏超声检查，并采用免疫比浊法测定hsCRP。采用受试者操作特征（ROC）分析评估所有可能的hsCRP检测不同程度肝脏炎症（ALT>44 U/L和ALT>88 U/L）的敏感性和特异性。根据代谢综合征（MS）的存在情况和ALT浓度将患者分为三组：第一组，患有MS且ALT>44 U/L（n = 39）；第二组，ALT>44 U/L但无MS（n = 105）；第三组，ALT≤44 U/L且无MS（n = 596）。
检测ALT>44 U/L患者的最佳hsCRP临界值为2.5 mg/L（敏感性66%；特异性50%），检测ALT>88 U/L患者的最佳hsCRP临界值为2.
