Clinical Laboratory Center, The First Hospital of Hebei Medical University, Shijiazhuang, China.
Eur Rev Med Pharmacol Sci. 2024 Feb;28(3):1052-1059. doi: 10.26355/eurrev_202402_35341.
This study delves into the role of N-terminal propeptide type III collagen (PIIINP) in the diagnosis and management of liver pathological changes associated with non-alcoholic steatohepatitis (NASH).
We collected baseline information, pathological data, and serum PIIINP levels of 168 patients diagnosed with non-alcoholic fatty liver disease (NAFLD) via ultrasound imaging in our hospital. Based on the non-alcoholic fatty liver disease activity score (NAS), patients with different NAFLD patterns were divided into a Definite NASH group and a Not/borderline group. Differences in PIIINP levels and pathological features between the two groups were compared and analyzed. The diagnostic value of PIIINP for NASH was evaluated using the receiver operating characteristic (ROC) curve.
Patients with NASH exhibited significantly higher values of homeostatic model assessment for insulin resistance (HOMA-IR), fibrosis biomarker fibrosis-4 (FIB-4), aminotransferase-to-platelet ratio index (APRI), and serum PIIINP levels than those classified as Not/borderline. A marked increase in the serum concentrations of PIIINP was observed with the severity of fatty degeneration, lobular inflammation, and hepatocellular ballooning. The AUC of PIIINP for diagnosing definite NASH was 0.766 (95% CI: 0.694, 0.839), APRI was 0.634 (95% CI: 0.549, 0.718), and FIB-4 was 0.621 (95% CI: 0.534, 0.708). The AUC of PIIINP for diagnosing definite NASH was significantly higher than that of APRI and FIB-4 (all p<0.05). Utilizing the predetermined threshold values for diagnostic parameters, the PIIINP measure demonstrated a sensitivity of 71.6% and a specificity of 73.6% in diagnosing definitive NASH when its value exceeded 7.72 ng/dL. This yielded a Youden index of 0.45. Similarly, when the APRI measure exceeded 0.21, it exhibited a sensitivity of 60.5% and a specificity of 63.2%, resulting in a Youden index of 0.24. Moreover, when the FIB-4 index surpassed 0.26, it showed a sensitivity of 46.9% and a specificity of 79.3%, culminating in a Youden index of 0.26.
NASH patients in this study exhibited significantly elevated PIIINP serum levels, which were closely associated with hepatocyte pathological changes. PIIINP demonstrated superior competence in diagnosing NASH than APRI and FIB-4 and thus offers a viable alternative for the clinical diagnosis of NASH.
本研究探讨了 N 端前肽 III 型胶原（PIIINP）在诊断和管理与非酒精性脂肪性肝炎（NASH）相关的肝病理变化中的作用。
我们收集了我院经超声成像诊断为非酒精性脂肪肝（NAFLD）的 168 例患者的基线信息、病理数据和血清 PIIINP 水平。根据非酒精性脂肪性肝病活动评分（NAS），将具有不同 NAFLD 模式的患者分为明确 NASH 组和非/边界组。比较分析两组间 PIIINP 水平和病理特征的差异。采用受试者工作特征（ROC）曲线评估 PIIINP 对 NASH 的诊断价值。
与非/边界组相比，NASH 患者的稳态模型评估胰岛素抵抗（HOMA-IR）、纤维化生物标志物纤维化-4（FIB-4）、天冬氨酸氨基转移酶与血小板比值指数（APRI）和血清 PIIINP 水平明显更高。随着脂肪变性、肝小叶炎症和肝细胞气球样变程度的加重，血清 PIIINP 浓度显著升高。PIIINP 诊断明确 NASH 的 AUC 为 0.766（95%CI：0.694，0.839），APRI 为 0.634（95%CI：0.549，0.718），FIB-4 为 0.621（95%CI：0.534，0.708）。PIIINP 诊断明确 NASH 的 AUC 明显高于 APRI 和 FIB-4（均 P<0.05）。利用诊断参数的预定阈值，当 PIIINP 值超过 7.72ng/dL 时，PIIINP 诊断明确 NASH 的敏感度为 71.6%，特异度为 73.6%，Youden 指数为 0.45。同样，当 APRI 测量值超过 0.21 时，其敏感性为 60.5%，特异性为 63.2%，Youden 指数为 0.24。此外，当 FIB-4 指数超过 0.26 时，其敏感性为 46.9%，特异性为 79.3%，Youden 指数为 0.26。
本研究中 NASH 患者的血清 PIIINP 水平显著升高，与肝细胞病理变化密切相关。PIIINP 在诊断 NASH 方面优于 APRI 和 FIB-4，为 NASH 的临床诊断提供了一种可行的替代方法。
