Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center of Diabetes, Shanghai, 200233, China.
Department of Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
Sci Rep. 2017 Jul 11;7(1):5095. doi: 10.1038/s41598-017-05257-5.
Fibroblast growth factor 21 (FGF21) and cytokeratin 18 (CK18) were previously reported to be elevated in nonalcoholic fatty liver disease (NAFLD). We aim to analyze the differential roles of FGF21, cell apoptosis marker CK18 fragment M30 and total cell death marker CK18 M65ED in monitoring the different stages of NAFLD spectrum in a population-based prospective cohort comprising 808 Chinese subjects. Predictive performances for monitoring the different stages of NAFLD were assessed by logistic regression and receiver-operating characteristic (ROC) curves. We found baseline FGF21 but not CK18 level was an independent predictor for the development of simple steatosis. NAFLD patients who had remission during follow-up had significantly lower baseline M30 levels than those who sustained NAFLD (84.74U/L [53.26-135.79] vs. 118.47U/L [87.16-188.89], P = 0.012). M65ED was independently predictive of progressing to suspected non-alcoholic steatohepatitis (NASH) in NAFLD patients. These results suggest that FGF21 can be used for early identification of hepatic steatosis. On the other hand, CK18 including M30 and M65ED, are predictive of the prognosis of NAFLD patients. FGF21 and CK18 might play differential roles and have complementary value in non-invasive identification and monitoring the outcome of NAFLD patients.
成纤维细胞生长因子 21（FGF21）和细胞角蛋白 18（CK18）先前被报道在非酒精性脂肪性肝病（NAFLD）中升高。我们旨在分析 FGF21、细胞凋亡标志物 CK18 片段 M30 和总细胞死亡标志物 CK18 M65ED 在监测包含 808 例中国受试者的基于人群的前瞻性队列中 NAFLD 谱的不同阶段中的差异作用。通过逻辑回归和接收者操作特性（ROC）曲线评估了监测 NAFLD 不同阶段的预测性能。我们发现，基线 FGF21 而不是 CK18 水平是发生单纯性脂肪变性的独立预测因子。随访期间缓解的 NAFLD 患者的基线 M30 水平明显低于持续存在 NAFLD 的患者（84.74U/L[53.26-135.79]比 118.47U/L[87.16-188.89]，P=0.012）。M65ED 可独立预测 NAFLD 患者进展为疑似非酒精性脂肪性肝炎（NASH）。这些结果表明，FGF21 可用于早期识别肝脂肪变性。另一方面，CK18（包括 M30 和 M65ED）可预测 NAFLD 患者的预后。FGF21 和 CK18 在非侵入性识别和监测 NAFLD 患者的结局方面可能发挥不同的作用，具有互补的价值。
