Department of Medicine, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Greece.
Ann Hepatol. 2013 Sep-Oct;12(5):749-57.
Insulin resistance (IR), adipocytokines, oxidative stress and hepatic apoptosis play a pathogenetic role in nonalcoholic fatty liver disease (NAFLD).
The evaluation of specific adipocytokines and markers of IR, oxidative stress and apoptosis in NAFLD patients; the introduction of a combined non-invasive index for nonalcoholic steatohepatitis (NASH).
Thirty patients with biopsy-proven NAFLD (15 with simple nonalcoholic fatty liver [NAFL], 15 with NASH) and 24 controls were recruited. Blood samples for total and high molecular weight (HMW) adiponectin, visfatin and tumor necrosis factor (TNF)-α, the apoptotic by-product cytokeratin (CK)-18, the reactive oxygen metabolites (ROMs) and standard biochemical tests were measured. Homeostatic model of assessment - insulin resistance (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI) were calculated.
Total and HMW adiponectin were significantly lower and TNF-α higher in either NAFL or NASH group compared to control group; CK-18 was significantly higher in NASH compared to either NAFL or control group. CHAI (an acronym of CK-18, HOMA-IR, AST Index) was calculated as the product of parameters being significantly different between NAFL and NASH groups. CHAI was significantly higher in NASH (24.2 [15.1-214.0]) compared to either NAFL (15.7 [6.8-22.7]) or control (5.1 [2.4-7.6]) group (p < 0.001) and significantly higher as the severity of steatosis, fibrosis, ballooning, lobular and portal inflammation advanced.
CHAI was escalating from controls to NAFL and NASH and was higher by increasing the severity of all the main histological lesions. However, a validation study is needed before introducing CHAI in clinical practice.
胰岛素抵抗（IR）、脂肪细胞因子、氧化应激和肝凋亡在非酒精性脂肪性肝病（NAFLD）中起致病作用。
评估 NAFLD 患者中特定的脂肪细胞因子以及 IR、氧化应激和凋亡的标志物；引入一种非酒精性脂肪性肝炎（NASH）的非侵入性综合指数。
招募了 30 名经活检证实的 NAFLD 患者（15 名单纯非酒精性脂肪肝 [NAFL]，15 名 NASH）和 24 名对照组。测量了全分子质量（HMW）和高分子质量（HMW） adiponectin、内脏脂肪素和肿瘤坏死因子（TNF）-α、凋亡副产物细胞角蛋白（CK）-18、活性氧代谢物（ROMs）以及标准生化测试的血液样本。计算了稳态模型评估的胰岛素抵抗（HOMA-IR）和定量胰岛素敏感指数检查（QUICKI）。
无论是在 NAFL 组还是 NASH 组，总 adiponectin 和 HMW adiponectin 均显著低于对照组，TNF-α显著高于对照组；CK-18 在 NASH 组显著高于 NAFL 组或对照组。CHAI（CK-18、HOMA-IR、AST 指数的缩写）的计算方法是在 NAFL 和 NASH 组之间有显著差异的参数的乘积。NASH 组的 CHAI（24.2[15.1-214.0]）明显高于 NAFL 组（15.7[6.8-22.7]）或对照组（5.1[2.4-7.6]）（p<0.001），随着脂肪变性、纤维化、气球样变、肝小叶和门脉炎症的严重程度的增加而升高。
CHAI 从对照组到 NAFL 和 NASH 逐渐升高，随着所有主要组织学病变严重程度的增加而升高。然而，在将 CHAI 引入临床实践之前，需要进行验证研究。
