Lesmana C Rinaldi A, Hasan Irsan, Budihusodo Unggul, Gani Rino A, Krisnuhoni Ening, Akbar Nurul, Lesmana Laurentius A
Department of Internal Medicine, Division of Hepatology, University of Indonesia, Jakarta, Indonesia.
J Dig Dis. 2009 Aug;10(3):201-6. doi: 10.1111/j.1751-2980.2009.00386.x.
The objectives of this study were to investigate the use of non-invasive biochemical markers to evaluate the severity of liver fibrosis in patients with non-alcoholic steatohepatitis (NASH).
This was a cross-sectional study of patients with histopathologically confirmed NASH between January 2005 and December 2006. The patients' characteristics were recorded and the body mass index was calculated for each patient. All patients underwent ultrasound-guided liver biopsy and a fibrosis assessment was performed using the Brunt criteria. The non-invasive laboratory markers measured were insulin resistance, tumor necrosis factor (TNF-alpha), type IV collagen and hyaluronic acid (HA).
Thirty patients were recruited, of whom 18 (60%) were men. Their mean age was 45 +/- 13.9 (18-71) years. About 83% of patients had fibrosis stage 1-2. In bivariate analysis, age, TNF-alpha and type IV collagen concentrations showed a weak but significant correlation with the fibrosis stage. When the patients were grouped into mild fibrosis (stages 1-2) and advanced fibrosis (stages 3-4), the mean concentrations of HA and type IV collagen were significantly higher in those with advanced fibrosis than those with mild fibrosis (180.8 +/- 49.63 vs 543.6 +/- 360.45 ng/mL; for HA; P = 0.026 and 125.3 +/- 32.11 vs 288.0 +/- 171.22 ng/mL for type IV collagen; P = 0.010).
Our study showed that the degree of liver fibrosis was significantly correlated with age, TNF-alpha and type IV collagen concentrations. The level of HA and type IV collagen could differentiate between mild (F1-2) and advanced fibrosis (F3-4).
本研究的目的是调查使用非侵入性生化标志物评估非酒精性脂肪性肝炎（NASH）患者肝纤维化严重程度的情况。
这是一项对2005年1月至2006年12月间组织病理学确诊为NASH的患者进行的横断面研究。记录患者的特征，并计算每位患者的体重指数。所有患者均接受超声引导下肝活检，并使用布伦特标准进行纤维化评估。所测量的非侵入性实验室标志物包括胰岛素抵抗、肿瘤坏死因子（TNF-α）、IV型胶原和透明质酸（HA）。
招募了30名患者，其中18名（60%）为男性。他们的平均年龄为45±13.9（18 - 71）岁。约83%的患者纤维化分期为1 - 2期。在双变量分析中，年龄、TNF-α和IV型胶原浓度与纤维化分期呈弱但显著的相关性。当将患者分为轻度纤维化（1 - 2期）和重度纤维化（3 - 4期）时，重度纤维化患者的HA和IV型胶原平均浓度显著高于轻度纤维化患者（HA：180.8±49.63 vs 543.6±360.45 ng/mL；P = 0.026；IV型胶原：125.3±32.11 vs 288.0±171.22 ng/mL；P = 0.010）。
我们的研究表明，肝纤维化程度与年龄、TNF-α和IV型胶原浓度显著相关。HA和IV型胶原水平可区分轻度（F1 - 2）和重度纤维化（F3 - 4）。
