Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Clin Gastroenterol Hepatol. 2012 Jun;10(6):651-6. doi: 10.1016/j.cgh.2012.01.017. Epub 2012 Feb 10.
BACKGROUND & AIMS: There are no clinically available biomarkers for nonalcoholic steatohepatitis (NASH); differentiating between steatosis and NASH requires histologic evaluation. Noninvasive methods are needed to replace liver biopsy and its associated risks. Production of very low density lipoprotein (VLDL) contributes to the development of NASH and might be used to distinguish steatosis from NASH. However, it is not possible to measure levels of VLDL directly in the clinic. Non-high-density lipoprotein-cholesterol (non-HDL-C) encompasses all apolipoprotein-B-containing lipoproteins, including VLDL, and can be calculated from standard lipid panels without additional cost.
We evaluated the ability of non-HDL-C to differentiate steatosis from NASH in a prospective study of 218 patients with suspected NASH (steatosis, n = 100 and NASH, n = 118).
Patients with NASH had a trend toward increased levels of non-HDL-C, compared with those with steatosis (P = .08). However, among subjects not on lipid-lowering medications, those with NASH had significantly higher levels of non-HDL-C (144.6 mg/dL) than those with steatosis (129.3 mg/dL; P = .025). This difference remained significant when adjusted for levels of cholesterol and triglycerides, indicating that the difference results from increased levels of apolipoprotein B including VLDL. These findings were validated in a cohort of 40 patients with steatosis or NASH who were not taking lipid-lowering agents. The NASH group had significantly higher levels of non-HDL-C than the steatosis group (162.8 vs 145.9 mg/dL; P = .04).
NASH is associated with significantly higher levels of non-HDL-C than steatosis in patients who do not take lipid-lowering agents. This low-cost biomarker could be used in noninvasive differentiation between steatosis and NASH.
目前尚无用于非酒精性脂肪性肝炎（NASH）的临床可用生物标志物；区分脂肪变性和 NASH 需要组织学评估。需要非侵入性方法来替代肝活检及其相关风险。极低密度脂蛋白（VLDL）的产生有助于 NASH 的发展，并且可以用于区分脂肪变性和 NASH。然而，在临床上不可能直接测量 VLDL 的水平。非高密度脂蛋白胆固醇（non-HDL-C）包含所有载脂蛋白 B 脂蛋白，包括 VLDL，可以通过标准脂质谱计算，无需额外费用。
我们在一项对 218 例疑似 NASH 患者（脂肪变性，n = 100 例，NASH，n = 118 例）的前瞻性研究中评估了 non-HDL-C 区分脂肪变性和 NASH 的能力。
与脂肪变性患者相比，NASH 患者的 non-HDL-C 水平呈上升趋势（P =.08）。然而，在未服用降脂药物的受试者中，NASH 患者的 non-HDL-C 水平（144.6 mg/dL）显著高于脂肪变性患者（129.3 mg/dL；P =.025）。在调整胆固醇和甘油三酯水平后，这种差异仍然显著，表明差异是由于包括 VLDL 在内的载脂蛋白 B 水平增加所致。这些发现在一组未服用降脂药物的脂肪变性或 NASH 患者（40 例）中得到验证。NASH 组的 non-HDL-C 水平显著高于脂肪变性组（162.8 vs 145.9 mg/dL；P =.04）。
在不服用降脂药物的患者中，与脂肪变性相比，NASH 与 non-HDL-C 水平显著升高相关。这种低成本的生物标志物可用于非侵入性区分脂肪变性和 NASH。
