Martini A, Fattovich G, Guido M, Bugianesi E, Biasiolo A, Ieluzzi D, Gallotta A, Fassina G, Merkel C, Gatta A, Negro F, Pontisso P
Department of Medicine, University of Padua, Padua, Italy.
Division of Gastroenterology and Endoscopy, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
J Viral Hepat. 2015 Oct;22(10):800-8. doi: 10.1111/jvh.12394. Epub 2015 Jan 22.
Nonalcoholic steatohepatitis (NASH) enhances the risk of progressive liver disease. In chronic hepatitis C (CHC), liver steatosis is frequent, especially in genotype 3, but its clinical significance is debated. As squamous cell carcinoma antigen (SCCA)-IgM has been associated with advanced liver disease and risk of tumour development, we evaluated its occurrence in CHC and the possible relation with NASH at liver biopsy. Using a validated ELISA, serum SCCA-IgM was measured in 91 patients with CHC at the time of liver biopsy performed before antiviral treatment, at the end of treatment and 6 months thereafter, and in 93 HCV-negative patients with histological diagnosis of nonalcoholic fatty liver disease, as controls. SCCA-IgM was detected in 33% of CHC patients and in 4% of controls. This biomarker was found more elevated in CHC patients with histological NASH, and at multivariate analysis, SCCA-IgM and HCV genotype 3 were independently associated with NASH [OR (95% CI): 6.94 (1.21-40) and 27.02 (4.44-166.6)]. As predictors of NASH, HCV genotype 3 and SCCA-IgM had a specificity and a sensitivity of 97% and 44%, and of 95% and 27%, respectively. PPV and NPV were 80% and 86% for HCV genotype 3 vs 73% and 72% for SCCA-IgM. In patients with sustained virologic response to therapy, SCCA-IgM levels decreased significantly, while these remained unchanged in nonresponders. In conclusion, SCCA-IgM is detectable in one-third of patients with CHC and significantly correlates with histological NASH.
非酒精性脂肪性肝炎（NASH）会增加进展性肝病的风险。在慢性丙型肝炎（CHC）中，肝脂肪变性很常见，尤其是在基因3型中，但其临床意义仍存在争议。由于鳞状细胞癌抗原（SCCA）-IgM与晚期肝病和肿瘤发生风险相关，我们评估了其在CHC中的发生率以及在肝活检时与NASH的可能关系。使用经过验证的酶联免疫吸附测定（ELISA），在91例接受抗病毒治疗前进行肝活检时、治疗结束时及之后6个月的CHC患者中，以及93例经组织学诊断为非酒精性脂肪性肝病的HCV阴性患者（作为对照）中测量血清SCCA-IgM。在33%的CHC患者和4%的对照中检测到SCCA-IgM。在组织学诊断为NASH的CHC患者中发现这种生物标志物水平更高，多因素分析显示，SCCA-IgM和HCV基因3型与NASH独立相关[比值比（95%可信区间）：6.94（1.21 - 40）和27.02（4.44 - 166.6）]。作为NASH的预测指标，HCV基因3型和SCCA-IgM的特异性和敏感性分别为97%和44%，以及95%和27%。HCV基因3型的阳性预测值（PPV）和阴性预测值（NPV）分别为80%和86%，而SCCA-IgM的PPV和NPV分别为73%和72%。在对治疗有持续病毒学应答的患者中，SCCA-IgM水平显著下降，而在无应答者中则保持不变。总之，三分之一的CHC患者可检测到SCCA-IgM，且其与组织学诊断的NASH显著相关。
