JGH: γ-谷氨酰转肽酶可以作为非酒精性脂肪肝晚期纤维化的生物标志物

2022-08-17 xuyihan MedSci原创

非酒精性脂肪性肝病指的是除外了酒精和其他明确的损肝因素,所导致的肝细胞内脂肪过度沉积为主要特征的临床病理综合征。这个疾病与胰岛素抵抗和遗传易感性密切相关的,是获得性的代谢应激性的肝损害。

非酒精性脂肪肝(NAFLD)是全世界最常见的慢性肝病,在一般人群中的患病率估计为 20-50%。高甘油三酯血症或高胆固醇血症相关的脂质代谢是NAFLD的危险因素,在心血管疾病中,已显示载脂蛋白 A1 (ApoA1) 或载脂蛋白 B (ApoB) 等比传统血脂测试能更好地预测疾病相关预后。此外,几个用于预测 NAFLD 中晚期纤维化或炎症活动的非侵入性测试显示脂质与晚期纤维化的发展有关。因此,本项研究旨在探究脂质谱和肝脏生化的变化是否与晚期纤维化有关。

研究人员纳入了2009年至2017年期间被诊断为非酒精性脂肪肝病 (NAFLD) 的患者。血液相关脂质谱的检测的变化计算如下:[(6个月时的值 - 基线时的值)/基线时的值] × 100。终点是由 NAFLD 纤维化评分确定的晚期纤维化。Cox比例风险模型用于确定预测晚期纤维化的因素。

在中位随访31.7个月后,1021名患者中有64名 (6.3%) 发生了肝脏晚期纤维化。晚期纤维化组的γ-谷氨酰转肽酶(GGT)水平(72.9 vs 51.1 IU/L;P= 0.23)和ΔGGT(+6.0% vs -6.9%;P=0.06)较高。在调整年龄和血小板计数后,ΔGGT(风险比 [HR] 1.03;P< 0.001)与晚期纤维化显着相关。阳性ΔGGT组显示出更高的晚期纤维化发生率,并且ΔGGT的1个标准差增量显示他汀类药物使用者(HR,1.35)和非使用者(HR,1.31;P< 0.05)与晚期纤维化显着相关。Cox模型证实 ΔGGT 与 NAFLD 纤维化评分呈正相关(P< 0.001)。ΔGGT在预测晚期纤维化方面的敏感性为 64.2%,特异性为 52.6%,阴性预测值为 98.3%。

 

本项研究证实最初被诊断患有NAFLD并接受治疗的患者改变和/或他汀类药物治疗后,γ-谷氨酰转肽酶(GGT)水平与ΔGGT可以很好的反映晚期纤维化的程度。

原始出处:

Yeonjung Ha. et al. Gamma-glutamyl transpeptidase dynamics as a biomarker for advanced fibrosis in non-alcoholic fatty liver disease. Journal of Gastroenterology and Hepatology.2022.

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