Iwadare Takanobu, Kimura Takefumi, Okumura Taiki, Wakabayashi Shun-Ichi, Nakajima Taro, Kondo Shohei, Kobayashi Hiroyuki, Yamashita Yuki, Sugiura Ayumi, Fujimori Naoyuki, Yamazaki Tomoo, Kunimoto Hideo, Shimamoto Satoshi, Igarashi Koji, Joshita Satoru, Tanaka Naoki, Umemura Takeji
Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan.
Consultation Center for Liver Diseases, Shinshu University Hospital, Matsumoto, Japan.
Commun Med (Lond). 2024 Apr 16;4(1):73. doi: 10.1038/s43856-024-00499-7.
Circulating autotaxin (ATX) levels have been reported to correlate with liver inflammation activity and liver fibrosis severity in patients with non-alcoholic fatty liver disease (NAFLD). The objective of this study is to investigate whether serum ATX could predict liver-related events (LRE) in NAFLD patients.
This retrospective investigation includes 309 biopsy-proven NAFLD patients registered at Shinshu University Hospital. All patients are followed for at least 1 year, during which time the prevalence of LRE, including newly developing hepatocellular carcinoma, hepatic encephalopathy, ascites, and esophagogastric varices, is investigated in relation to ATX levels at the time of liver biopsy.
During the median follow-up period of 7.0 years, LRE are observed in 20 patients (6.5%). The area under the receiver operating characteristic curve and cut-off value of serum ATX for predicting LRE are 0.81 and 1.227 mg/l, respectively. Multivariate Cox proportional hazards models for LRE determine ATX and advanced fibrosis as independently associated factors. Furthermore, in a competing risk analysis that considered non-liver-related death as a competing event, ATX (HR 2.29, 95% CI 1.22-4.30, p = 0.010) is identified as an independent factor associated with LRE, along with advanced fibrosis (HR 8.01, 95% CI 2.10-30.60, p = 0.002). The predictive utility of ATX for LRE is validated in an independent cohort.
Serum ATX may serve as a predictive marker for LRE in patients with NAFLD.
据报道，非酒精性脂肪性肝病（NAFLD）患者的循环自分泌运动因子（ATX）水平与肝脏炎症活动及肝纤维化严重程度相关。本研究的目的是调查血清ATX是否可预测NAFLD患者的肝脏相关事件（LRE）。
这项回顾性研究纳入了309例在信州大学医院登记且经活检证实的NAFLD患者。所有患者均随访至少1年，在此期间，调查包括新发生的肝细胞癌、肝性脑病、腹水和食管胃静脉曲张在内的LRE的发生率与肝活检时ATX水平的关系。
在中位随访期7.0年期间，20例患者（6.5%）出现LRE。预测LRE的受试者工作特征曲线下面积及血清ATX的临界值分别为0.81和1.227mg/l。LRE的多变量Cox比例风险模型确定ATX和高级纤维化是独立相关因素。此外，在一项将非肝脏相关死亡视为竞争事件的竞争风险分析中，ATX（风险比2.29，95%置信区间1.22 - 4.30，p = 0.010）与高级纤维化（风险比8.01，95%置信区间2.10 - 30.60，p = 0.002）一样，被确定为与LRE相关的独立因素。ATX对LRE的预测效用在一个独立队列中得到验证。
血清ATX可能作为NAFLD患者LRE的预测标志物。
