Öz
Objective: Non-alcoholic fatty liver disease (NAFLD) is affecting people worldwide with increasing prevalence. Non-invasive tests are required for both diagnosis and staging of the disease. We aimed to evaluate diagnostic accuracy of routine liver enzymes and cytokines in NAFLD. Methods: A total of 88 cases, aged between 20 and 62 years, were included in the study. Serum ALT, AST, GGT, triglyceride, TNF-alpha, IL-6 and IL-8 were measured in 40 patients with NAFLD and in 48 healthy control patients with similar BMI and demographic characteristics. Diagnostic performances of serum biomarkers for diagnosis of NAFLD were evaluated with ROC analysis. Results: ALT and AST showed good diagnostic performance in predicting patients with NAFLD in the overall group (AUC=0.817; 95% CI[0.721-0.913], AUC=0.815; 95% CI[0.718-0.911] respectively) but in obese subjects ALT and AST showed poor performance (AUC=0.659; 95% CI[0.478-0.841], AUC=0.680; 95% CI[0.498-0.861] respectively). Among cytokines TNF-alpha showed best performance in the diagnosis of NAFLD in both overall group and obese subjects (AUC=0.892; 95% CI[0.824- 0.959], AUC=0.858; 95% CI[0.739-0.977] respectively). The optimal cut off value for TNF-alpha was 10.65pg/ml with a sensitivity of 75% and a specificity of 93% in the overall group. IL-6 and IL-8 showed poor performance. Conclusion: TNF-alpha may be a good parameter for predicting patients with NAFLD. J Clin Exp Invest 2015; 6 (1): 16-20 Key words: TNF-alpha, IL-8, IL 6, non-alcoholic fatty liver disease
Anahtar Kelimeler
Kaynakça
- Hjelkrem M.C, Torres D.M, Harrison S.A. Nonalcoholic
- fatty liver disease. Minerva Med 2008;99:583-593.
- Jarrar M.H, Baranova A, Collantes R, et al. Adipokines
- and cytokines in non-alcoholic fatty liver disease. Aliment
- Pharmacol Ther 2008;27:412-421.
- Bjornsson E. The clinical aspects of non-alcoholic fatty liver
- disease. Minerva Gastroenterol Dietol 2008;54:7-18.
- Wang J.K, Feng Z.W, Li Y.C, et al. Association of tumor
- necrosis factor-alpha gene promoter polymorphism at
- sites -308 and -238 with non-alcoholic fatty liver disease:
- a meta-analysis. J Gastroenterol Hepatol 2012;27:670-
- -
- Goren B and Fen T. Non-alkolik yağlı karaciğer hastalığı.
- Türkiye Klinikleri J Med Sci 2005;25:841-850.
- Tilg H. The role of cytokines in non-alcoholic fatty liver
- disease. Dig Dis 2010;28:179-185.
- Marchesini G, Brizi M, Morselli L.A.M, et al. Association
- of nonalcoholic fatty liver disease with insulin resistance.
- Am J Med 1999;107:450-455.
- Schreuder T.C, Verwer B.J, van Nieuwkerk C.M, Mulder
- CJ. Nonalcoholic fatty liver disease: an overview of current
- insights in pathogenesis, diagnosis and treatment.
- World J Gastroenterol 2008;14:2474-2486.
- Pearce S.G, Thosani N.C, Pan J.J. Noninvasive biomarkers
- for the diagnosis of steatohepatitis and advanced
- fibrosis in NAFLD. Biomark Res 2013;1:7.
- Kunde S.S, Lazenby A.J, Clements R.H, Abrams GA.
- Spectrum of NAFLD and diagnostic implications of the
- proposed new normal range for serum ALT in obese
- women. Hepatology 2005;42:650-656.
- Yamada C, Mitsuhashi T, Hiratsuka N, et al. Optimal reference
- interval for homeostasis model assessment of
- insulin resistance in a Japanese population. J Diabetes
- Invest 2011;2:373-376.
- Bedogni G, Miglioli L, Masutti F, et al. Prevalence of and
- risk factors for nonalcoholic fatty liver disease: the Dionysos
- nutrition and liver study. Hepatology 2005;42:44-
- -
- Mofrad P, Contos M.J, Haque M, et al. Clinical and histologic
- spectrum of nonalcoholic fatty liver disease associated
- with normal ALT values. Hepatology 2003;37:1286-
- -
- Fracanzani A.L, Valenti L, Bugianesi E, et al. Risk of
- severe liver disease in nonalcoholic fatty liver disease
- with normal aminotransferase levels: a role for insulin
- resistance and diabetes. Hepatology 2008;48:792-798.
- Zelber S.S, Lotan R, Shlomai A, et al. Predictors for incidence
- and remission of NAFLD in the general population
- during a seven-year prospective follow-up. J Hepatol
- ;56:1145-1151.
- Caballeria L, Arteaga I, Pera G, et al. [Risk factors associated
- with non-alcoholic fatty liver disease: a casecontrol
- study]. Med Clin (Barc) 2013;141:233-239.
- Abiru S, Migita K, Maeda Y, et al. Serum cytokine and
- soluble cytokine receptor levels in patients with non-alcoholic
- steatohepatitis. Liver Int 2006;26:39-45.
- Hui JM, Hodge A, Farrell G.C, et al. Beyond insulin resistance
- in NASH: TNF-alpha or adiponectin? Hepatology
- ;40:46-54.
- Lebensztejn DM, Kowalczuk D, Tarasow E, et al. Tumor
- necrosis factor alpha and its soluble receptors in obese
- children with NAFLD. Adv Med Sci 2010;55:74-79.
- Manco M, Marcellini M, Giannone G, Nobili V. Correlation
- of serum TNF-alpha levels and histologic liver injury
- scores in pediatric nonalcoholic fatty liver disease. Am J
- Clin Pathol 2007;127:954-960.
Serum karaciğer enzimleri ve sitokinlerin alkolik olmayan yağlı karaciğer hastalığında tanısal performansları
Öz
Amaç: Alkolik olmayan yağlı karaciğer hastalığı gittikçe artan prevalansla dünya çapında insanları etkilemektedir. Bu hastalığın tanısı ve evrelendirilmesi için invaziv olmayan testlere ihtiyaç vardır. Bu çalışmada rutin karaciğer enzimleri ve sitokinlerin alkolik olmayan yağlı karaciğer hastalığında tanısal performanslarını değerlendirmeyi amaçladık.Yöntemler: 20-62 yaşları arasında 88 kişi çalışmaya dahil edildi. Serum ALT, AST, GGT, trigliserid, TNF-alfa, IL-6 ve IL-8 düzeyleri 40 yağlı karaciğer hastası ve benzer VKİ ve demografik özellikleri olan 48 sağlıklı bireyde ölçüldü. Serum biyobelirteçlerinin yağlı karaciğer hastalığındaki tanısal performansları ROC analizi ile değerlendirildi.Bulgular: ALT ve AST tüm grupta yağlı karaciğer hastalığı olan bireyleri belirlemede iyi performans gösterdi (AUC=0,817; %95 CI[0,721-0,913], AUC=0,815; %95 CI[0,718-0,911] sırasıyla) ancak obez bireylerde ALT ve AST zayıf performans gösterdi (AUC=0,659; %95 CI[0,478-0,841], AUC=0,680; %95 CI[0,498-0,861] sırasıyla). Sitokinler arasında TNF-alfa yağlı karaciğer hastalığı tanısında tüm grupta ve obez hastalarda en iyi performansı gösterdi (AUC=0,892; %95 CI[0,824-0,959], AUC=0,858; %95 CI[0,739-0,977] sırasıyla). Tüm grupta TNF-alfa için en iyi cut-off değeri %75 sensitivite ve %93 spesifisite ile 10,65pg/mL bulundu. IL6 ve IL8 zayıf performans gösterdi.Sonuç: TNF-alfa alkolik olmayan yağlı karaciğer hastalarını tespit etmede iyi bir parametre olabilir
Anahtar Kelimeler
TNF-alfa IL-8 IL-6 alkolik olmayan yağlı karaciğer hastalığı
Kaynakça
- Hjelkrem M.C, Torres D.M, Harrison S.A. Nonalcoholic
- fatty liver disease. Minerva Med 2008;99:583-593.
- Jarrar M.H, Baranova A, Collantes R, et al. Adipokines
- and cytokines in non-alcoholic fatty liver disease. Aliment
- Pharmacol Ther 2008;27:412-421.
- Bjornsson E. The clinical aspects of non-alcoholic fatty liver
- disease. Minerva Gastroenterol Dietol 2008;54:7-18.
- Wang J.K, Feng Z.W, Li Y.C, et al. Association of tumor
- necrosis factor-alpha gene promoter polymorphism at
- sites -308 and -238 with non-alcoholic fatty liver disease:
- a meta-analysis. J Gastroenterol Hepatol 2012;27:670-
- -
- Goren B and Fen T. Non-alkolik yağlı karaciğer hastalığı.
- Türkiye Klinikleri J Med Sci 2005;25:841-850.
- Tilg H. The role of cytokines in non-alcoholic fatty liver
- disease. Dig Dis 2010;28:179-185.
- Marchesini G, Brizi M, Morselli L.A.M, et al. Association
- of nonalcoholic fatty liver disease with insulin resistance.
- Am J Med 1999;107:450-455.
- Schreuder T.C, Verwer B.J, van Nieuwkerk C.M, Mulder
- CJ. Nonalcoholic fatty liver disease: an overview of current
- insights in pathogenesis, diagnosis and treatment.
- World J Gastroenterol 2008;14:2474-2486.
- Pearce S.G, Thosani N.C, Pan J.J. Noninvasive biomarkers
- for the diagnosis of steatohepatitis and advanced
- fibrosis in NAFLD. Biomark Res 2013;1:7.
- Kunde S.S, Lazenby A.J, Clements R.H, Abrams GA.
- Spectrum of NAFLD and diagnostic implications of the
- proposed new normal range for serum ALT in obese
- women. Hepatology 2005;42:650-656.
- Yamada C, Mitsuhashi T, Hiratsuka N, et al. Optimal reference
- interval for homeostasis model assessment of
- insulin resistance in a Japanese population. J Diabetes
- Invest 2011;2:373-376.
- Bedogni G, Miglioli L, Masutti F, et al. Prevalence of and
- risk factors for nonalcoholic fatty liver disease: the Dionysos
- nutrition and liver study. Hepatology 2005;42:44-
- -
- Mofrad P, Contos M.J, Haque M, et al. Clinical and histologic
- spectrum of nonalcoholic fatty liver disease associated
- with normal ALT values. Hepatology 2003;37:1286-
- -
- Fracanzani A.L, Valenti L, Bugianesi E, et al. Risk of
- severe liver disease in nonalcoholic fatty liver disease
- with normal aminotransferase levels: a role for insulin
- resistance and diabetes. Hepatology 2008;48:792-798.
- Zelber S.S, Lotan R, Shlomai A, et al. Predictors for incidence
- and remission of NAFLD in the general population
- during a seven-year prospective follow-up. J Hepatol
- ;56:1145-1151.
- Caballeria L, Arteaga I, Pera G, et al. [Risk factors associated
- with non-alcoholic fatty liver disease: a casecontrol
- study]. Med Clin (Barc) 2013;141:233-239.
- Abiru S, Migita K, Maeda Y, et al. Serum cytokine and
- soluble cytokine receptor levels in patients with non-alcoholic
- steatohepatitis. Liver Int 2006;26:39-45.
- Hui JM, Hodge A, Farrell G.C, et al. Beyond insulin resistance
- in NASH: TNF-alpha or adiponectin? Hepatology
- ;40:46-54.
- Lebensztejn DM, Kowalczuk D, Tarasow E, et al. Tumor
- necrosis factor alpha and its soluble receptors in obese
- children with NAFLD. Adv Med Sci 2010;55:74-79.
- Manco M, Marcellini M, Giannone G, Nobili V. Correlation
- of serum TNF-alpha levels and histologic liver injury
- scores in pediatric nonalcoholic fatty liver disease. Am J
- Clin Pathol 2007;127:954-960.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Bölüm | Araştırma Yazısı |
| Yazarlar | |
| Yayımlanma Tarihi | 10 Mayıs 2015 |
| Yayımlandığı Sayı | Yıl 2015 |