Noninvasive predictors of nonalcoholic steatohepatitis in Korean patients with histologically proven nonalcoholic fatty liver disease

被引：25

作者：

Kim, Young Seok ^{[1
]}

Jung, Eun Sun ^{[2
]}

Hur, Wonhee ^{[3
,4
]}

Bae, Si Hyun ^{[5
]}

Choi, Jong Young ^{[5
]}

Song, Myeong Jun ^{[5
]}

Kim, Chang Wook ^{[6
]}

Jo, Se Hyun ^{[7
]}

Lee, Chang Don ^{[6
]}

Lee, Young Sok ^{[8
]}

Choi, Sang Wook ^{[9
]}

Yang, Jin Mo ^{[10
]}

Jang, Jeong Won ^{[11
]}

Kim, Sang Gyune ^{[1
]}

Jung, Seung Won ^{[12
]}

Kim, Hee Kyung ^{[13
]}

Chae, Hee Bok ^{[14
]}

Yoon, Seung Kew ^{[5
]}

机构：

[1] Soon Chun Hyang Univ, Soon Chun Hyang Univ Hosp Bucheon, Coll Med, Dept Internal Med, Bucheon, South Korea

[2] Catholic Univ Korea, Seoul St Marys Hosp, Coll Med, Dept Pathol, Seoul, South Korea

[3] Catholic Univ Korea, Liver Res Ctr, Coll Med, Seoul, South Korea

[4] Catholic Univ Korea, WHO Collaborating Ctr Viral Hepatitis, Coll Med, Seoul, South Korea

[5] Catholic Univ Korea, Seoul St Marys Hosp, Coll Med, Dept Internal Med, Seoul, South Korea

[6] Catholic Univ Korea, Uijeongbu St Marys Hosp, Coll Med, Dept Internal Med, Uijongbu, South Korea

[7] Catholic Univ Korea, Yeouido St Marys Hosp, Coll Med, Dept Internal Med, Seoul, South Korea

[8] Catholic Univ Korea, Bucheon St Marys Hosp, Coll Med, Dept Internal Med, Bucheon, South Korea

[9] Catholic Univ Korea, St Pauls Hosp, Coll Med, Dept Internal Med, Seoul, South Korea

[10] Catholic Univ Korea, St Vincents Hosp, Coll Med, Dept Internal Med, Suwon, South Korea

[11] Catholic Univ Korea, Incheon St Marys Hosp, Coll Med, Dept Internal Med, Incheon, South Korea

[12] Soon Chun Hyang Univ, Hosp Seoul, Coll Med, Dept Internal Med, Seoul, South Korea

[13] Soon Chun Hyang Univ, Hosp Bucheon, Coll Med, Dept Pathol, Bucheon, South Korea

[14] Chungbuk Natl Univ, Coll Med, Dept Internal Med, Cheongju, South Korea

来源：

CLINICAL AND MOLECULAR HEPATOLOGY | 2013年 / 19卷 / 02期

关键词：

Nonalcoholic fatty liver disease; Cytokeratin-18; Ferritin;

D O I：

10.3350/cmh.2013.19.2.120

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background/Aims: The aims of this study were (1) to identify the useful clinical parameters of noninvasive approach for distinguishing nonalcoholic steatohepatitis (NASH) from nonalcoholic fatty liver disease (NAFLD), and (2) to determine whether the levels of the identified parameters are correlated with the severity of liver injury in patients with NASH. Methods: One hundred and eight consecutive patients with biopsy-proven NAFLD (age, 39.8 +/- 13.5 years, mean +/- SD; males, 67.6%) were prospectively enrolled from 10 participating centers across Korea. Results: According to the original criteria for NAFLD subtypes, 67 patients (62.0%) had NASH (defined as steatosis with hepatocellular ballooning and/or Mallory-Denk bodies or fibrosis >= 2). Among those with NAFLD subtype 3 or 4, none had an NAFLD histologic activity score (NAS) below 3 points, 40.3% had a score of 3 or 4 points, and 59.7% had a score > 4 points. Fragmented cytokeratin-18 (CK-18) levels were positively correlated with NAS (r=0.401), as well as NAS components such as lobular inflammation (r=0.387) and ballooning (r=0.231). Fragmented CK-18 was also correlated with aspartate aminotransferase (r=0.609), alanine aminotransferase (r=0.588), serum ferritin (r=0.432), and the fibrosis stage (r=0.314). A fragmented CK- 18 cutoff level of 235.5 U/L yielded sensitivity, specificity, and positive and negative predictive values of 69.0%, 64.9%, 75.5% (95% CI 62.4-85.1), and 57.1% (95% CI 42.2-70.9), respectively, for the diagnosis of NASH. Conclusions: Serum fragmented CK-18 levels can be used to distinguish between NASH and NAFL. Further evaluation is required to determine whether the combined measurement of serum CK-18 and ferritin levels improves the diagnostic performance of this distinction.

引用

页码：120 / 130

页数：11

共 47 条

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