Department of Gastroenterology and Hepatology, Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama University, Okayama, Japan.
Department of Gastroenterology, Okayama City Hospital, Okayama, Japan.
J Appl Lab Med. 2020 Nov 1;5(6):1206-1215. doi: 10.1093/jalm/jfaa044.
Nonalcoholic fatty liver disease (NAFLD) is the most common type of liver disease, but it is difficult to distinguish its pathogenic phenotype, nonalcoholic steatohepatitis (NASH), from nonalcoholic fatty liver (NAFL) without a liver biopsy. We analyzed serum lipids, including low-density lipoprotein triglyceride (LDL-TG), to elucidate their usefulness for diagnosing NASH.
Serum samples obtained from 35 NASH and 9 NAFL biopsy-confirmed patients and 6 healthy volunteers (HLT) were studied for 13 lipid-related markers and compared between HLT, NAFL, and NASH groups. The relationship between histological findings and the lipid markers was also analyzed.
There were significant differences in triglyceride, LDL-TG, the ratio of LDL-TG to the LDL-cholesterol (LDL-TG/LDL-C), small dense LDL-C, and apolipoprotein E between the three groups. Among the 5 lipid components, serum LDL-TG level and the ratio of LDL-TG to the LDL-cholesterol (LDL-TG/LDL-C) were significantly elevated in NASH. The median concentrations of LDL-TG in HLT, NAFL, and NASH were 9, 15, and 20 mg/dL (P < 0.001), and those of LDL-TG/LDL-C were 0.097, 0.102, and 0.173 (P < 0.001), respectively. Although the degree of steatosis was not correlated with the LDL-TG/LDL-C, the ratio was significantly higher in patients with lobular inflammation (P = 0.071), ballooning (P = 0.031), and fibrosis (P < 0.001). The area under the receiver operating characteristic curve of the ratio for distinguishing NASH from NAFL was 0.857. The rest of studied markers showed no significant utility.
Serum LDL-TG levels and the LDL-TG/LDL-C ratio might serve as simple and noninvasive diagnostic biomarkers for NASH.
非酒精性脂肪性肝病（NAFLD）是最常见的肝病类型，但在没有肝活检的情况下，很难将其致病表型非酒精性脂肪性肝炎（NASH）与非酒精性脂肪肝（NAFL）区分开来。我们分析了血清脂质，包括低密度脂蛋白甘油三酯（LDL-TG），以阐明其在诊断 NASH 中的作用。
研究了 35 例 NASH 和 9 例经肝活检证实的 NAFL 患者和 6 名健康志愿者（HLT）的血清样本，检测了 13 种与脂质相关的标志物，并比较了 HLT、NAFL 和 NASH 组之间的差异。还分析了组织学发现与脂质标志物之间的关系。
三组之间的甘油三酯、LDL-TG、LDL-TG 与 LDL 胆固醇（LDL-TG/LDL-C）的比值、小而密 LDL-C 和载脂蛋白 E 存在显著差异。在这 5 种脂质成分中，NASH 患者血清 LDL-TG 水平和 LDL-TG 与 LDL 胆固醇（LDL-TG/LDL-C）的比值显著升高。HLT、NAFL 和 NASH 中 LDL-TG 的中位数浓度分别为 9、15 和 20mg/dL（P<0.001），LDL-TG/LDL-C 分别为 0.097、0.102 和 0.173（P<0.001）。虽然脂肪变性程度与 LDL-TG/LDL-C 无关，但在具有小叶炎症（P=0.071）、气球样变（P=0.031）和纤维化（P<0.001）的患者中，该比值显著更高。区分 NASH 与 NAFL 的 LDL-TG/LDL-C 比值的受试者工作特征曲线下面积为 0.857。其余研究标志物均无显著作用。
血清 LDL-TG 水平和 LDL-TG/LDL-C 比值可能是 NASH 的简单、无创诊断生物标志物。
