Vuppalanchi Raj, Gould Robert J, Wilson Laura A, Unalp-Arida Aynur, Cummings Oscar W, Chalasani Naga, Kowdley Kris V
Indiana University School of Medicine, Indianapolis, IN, USA.
Centre for Liver Disease, Virginia Mason Medical Centre, Seattle, WA, USA.
Hepatol Int. 2012 Jan;6(1):379-85. doi: 10.1007/s12072-011-9277-8. Epub 2011 May 10.
Some studies have suggested that autoantibodies might define a subcategory and phenotype of nonalcoholic fatty liver disease (NAFLD) associated with advanced histological features. We evaluated the relationship between the presence of serum autoantibodies and liver histology in a large cohort of well-characterized patients with NAFLD.
A total of 864 NAFLD patients participating in two prospective multicentre clinical studies underwent testing for serum autoantibodies within 24 months of a liver biopsy. Liver histology was compared between the patients with and without ANA ≥ 1:160 or ASMA ≥ 1:40 or both.
Autoantibodies were present in 182 patients (21%). There was no difference in age, gender, race, body mass index (BMI), homeostasis model assessment of insulin resistance (HOMA-IR), or history of diabetes between the two groups. Biopsies in subjects with autoantibodies were less likely to have moderate-to-severe steatosis (i.e., >33%) compared to controls (57.1 vs. 43.0%, P value = 0.0006). Lobular inflammation (46.7 vs. 47.5%), ballooning degeneration (38.5 vs. 42.5%), and advanced fibrosis (33.2 vs. 29.3%) were not different between the two groups. Histologic evidence of 'definite' NASH did not differ significantly between the two groups (55.5 vs. 58.9%). After adjusting for age, gender, BMI, race, and diabetes, the presence of autoantibodies was independently associated with lower prevalence of moderate-to-severe steatosis [odds ratio (OR), 0.58; 95% confidence interval (CI), 0.41-0.82; P = 0.01].
Autoantibodies are frequently positive in NAFLD in the absence of autoimmune hepatitis and their occurrence is not associated with more advanced histologic features.
一些研究表明，自身抗体可能定义了与晚期组织学特征相关的非酒精性脂肪性肝病（NAFLD）的一个亚类和表型。我们在一大群特征明确的NAFLD患者中评估了血清自身抗体的存在与肝脏组织学之间的关系。
共有864名参与两项前瞻性多中心临床研究的NAFLD患者在肝活检的24个月内接受了血清自身抗体检测。比较了抗核抗体（ANA）≥1:160或抗平滑肌抗体（ASMA）≥1:40或两者均有的患者与无上述情况患者的肝脏组织学。
182名患者（21%）存在自身抗体。两组在年龄、性别、种族、体重指数（BMI）、胰岛素抵抗稳态模型评估（HOMA-IR）或糖尿病病史方面无差异。与对照组相比，有自身抗体的受试者活检时出现中度至重度脂肪变性（即>33%）的可能性较小（57.1%对43.0%，P值=0.0006）。两组之间小叶炎症（46.7%对47.5%）、气球样变性（38.5%对42.5%）和晚期纤维化（33.2%对29.3%）无差异。两组之间“明确的”非酒精性脂肪性肝炎（NASH）的组织学证据无显著差异（55.5%对58.9%）。在调整年龄、性别、BMI、种族和糖尿病因素后，自身抗体的存在与中度至重度脂肪变性的较低患病率独立相关[比值比（OR），0.58；95%置信区间（CI），0.41-0.82；P=0.01]。
在无自身免疫性肝炎的情况下，NAFLD患者中自身抗体经常呈阳性，且其出现与更晚期的组织学特征无关。
