Yoneda Masato, Mawatari Hironori, Fujita Koji, Yonemitsu Kyoko, Kato Shingo, Takahashi Hirokazu, Kirikoshi Hiroyuki, Inamori Masahiko, Nozaki Yuichi, Abe Yasunobu, Kubota Kensuke, Saito Satoru, Iwasaki Tomoyuki, Terauchi Yasuo, Togo Shinji, Maeyama Shiro, Nakajima Atsushi
Division of Gastroenterology, Yokohama City University Hospital, 3-9 Fuku-ura, Yokohama, Kanagawa 236-0004, Japan.
J Gastroenterol. 2007 May;42(5):375-81. doi: 10.1007/s00535-007-2014-3. Epub 2007 May 25.
The changes in nonalcoholic fatty liver disease range over a wide spectrum, extending from simple steatosis to nonalcoholic steatohepatitis (NASH). We investigated the clinical usefulness of the type IV collagen 7s domain and hyaluronic acid for predicting the severity of fibrosis before progression to the cirrhotic stage in NASH patients.
The type IV collagen 7s domain and hyaluronic acid were measured in 72 patients with histologically verified NASH.
In a univariate analysis, marked elevation of hyaluronic acid and the type IV collagen 7s domain was observed in the NASH patients with advanced fibrosis compared with those with mild fibrosis (P = 0.0028, P = 0.0006, respectively). For detection of NASH with advanced fibrosis, the area under the receiver-operating characteristic curves for type IV collagen 7s domain and hyaluronic acid were 0.767 and 0.754, respectively. However, multiple regression analysis revealed that the type IV collagen 7s domain, but not hyaluronic acid, was significantly elevated in patients with advanced fibrosis even after adjustment for age, sex, platelet count, prothrombin time, aspartate aminotransferase/alanine aminotransferase ratio, body mass index, and presence of underlying type 2 diabetes mellitus, all of which have previously been reported as useful predictors of advanced fibrosis in patients with NASH (P = 0.0127, P = 0.2804, respectively).
This is the first report to demonstrate a consistent and profound elevation of the type IV collagen 7s domain in NASH patients with advanced fibrosis (before progression to the stage of cirrhosis) compared with those with mild fibrosis.
非酒精性脂肪性肝病的变化范围广泛，从单纯性脂肪变性到非酒精性脂肪性肝炎（NASH）。我们研究了IV型胶原7s结构域和透明质酸在预测NASH患者进展至肝硬化阶段之前纤维化严重程度方面的临床实用性。
对72例经组织学证实为NASH的患者测定了IV型胶原7s结构域和透明质酸。
在单因素分析中，与轻度纤维化的NASH患者相比，重度纤维化的NASH患者中透明质酸和IV型胶原7s结构域显著升高（分别为P = 0.0028，P = 0.0006）。对于检测重度纤维化的NASH，IV型胶原7s结构域和透明质酸的受试者工作特征曲线下面积分别为0.767和0.754。然而，多因素回归分析显示，即使在调整了年龄、性别、血小板计数、凝血酶原时间、天冬氨酸氨基转移酶/丙氨酸氨基转移酶比值、体重指数以及是否存在2型糖尿病（所有这些先前均被报道为NASH患者重度纤维化的有用预测指标）后，重度纤维化患者中IV型胶原7s结构域仍显著升高，而透明质酸则无显著变化（分别为P = 0.0127，P = 0.2804）。
这是首份报告，证明与轻度纤维化的NASH患者相比，重度纤维化（进展至肝硬化阶段之前）的NASH患者中IV型胶原7s结构域持续且显著升高。
