The Noninvasive Serological Diagnosis Of Non-alcoholic Steatohepatitis

Objective:Non-alcoholic steatohepatitis(NASH)is the most critical histological change in non-alcoholic fatty liver disease(NAFLD).Further progression of the disease can lead to cirrhosis and hepatocellular carcinoma.Early diagnosis of NASH and interventions will improve histological prognosis.The current globally accepted gold standard for NASH diagnosis is pathological biopsy and there is a lack of non-invasive serological diagnosis.The purpose of this study was to investigate Mac-2Bp、Fuc-Hpt、Hcy in serum.The relationship between the level and progression of NAFLD disease provides evidence for the noninvasive diagnosis of NASH.Methods:1.Our research screen of 108 patients from May 2017 to July 2017 at the"Medical Examination Center of the First Affiliated Hospital of Kunming Medical University" and conducted FibroTouch examination.According to the results of FibroTouch,45 cases were classified into NAFLD group and 63 cases were normal group.There were 51 cases in NASH group and 57 cases in normal group.They were divided into F1,F2,F3,and F4 groups according to NASH fibrosis grade.All subjects measured abdominal circumference,height and weight,and calculated their body mass index(BMI).After fasting for 12 hours,we collected 5 ml of fasting venous blood in the early morning of the next day to detect serum alanine transferase(ALT),Aspartate aminotransferase(AST),r-glutamate aminotransferase(GGT),total bilirubin(TB),direct bilirubin(DB),indirect bilirubin(IDBIL),base Phosphatase(ALP),triglyceride(TG),total cholesterol(TC),high-density lipoprotein(HDL-C),low-density lipoprotein(LDL-C)levels,Uric acid(UA),Fasting Plasma Glucose(FPG).Serum levels of Mac-2 bingding protein(Mac-2Bp),Fucosylate haptoglobin(Fuc-Hpt),and Homocysteine(Hcy)levels were determined by ELISA.According to different groups and values for correlation analysis.2.Using SPSS 17.0 to build the multi-factor unconditioned Logistic regression model.p<0.05 indicates that the difference was statistically significant.According to different data,the mean standard deviation,,median,quartile,t-test,the Wilcoxon Mann-Whitney test,Kruskal-Wallis H,χ square test.Fisher LSD-t was used to compare data between multiple groups.The linear regression was used to evaluate the correlation between variables and to make a regression diagnosis of the regression model’s normality,homogeneity of variance,and independence.The ROC curve was analyzed statistically.Results:1.After two independent samples of t test,abdominal circumference,BMI,and T2DM were related to NALFD,and the difference was statistically significant(p<0.05).And in the low-grade,middle-grade and high-grade fatty liver,BMI,abdominal circumference difference is still statistically significant(p<0.05).2.For NAFLD group and normal group,the differences of HDL-C,TC,Mac-2bp and uric acid were statistically significant(p<0.05).In the analysis of variance of low-grade,middle-grade and high-grade fatty liver,HDL-C is negative correlation(p<0.05).3.For NASH group and control group,ALT,AST,GGT and NASH is correlated(p<0.05),and in the comparison of liver fibrosis grade of F1,F2,F3,and F4,ALT and AST levels were associated with liver fibrosis.The liver fibrosis grade is increasing and the difference was statistically significant(p<0.05).There is no significant difference in ALP level between NASH group and normal group,but the difference in NASH fibrosis grade was statistically significant(p<0.05).The higher the grade,the higher the ALP level.4.After Wilcoxon Mann-Whitney test,The serum level of Mac-2Bp in the NAFLD group was low(p<0.05),indicating that it had diagnostic significance for NAFLD,indicating that it can be used as a non-invasive diagnostic predictor of NAFLD.The area under the ROC curve of serum Mac-2Bp level was 0.754,the best cut-off point was 4.655ug/ml with a sensitivity of 77.8%and a specificity of 66.7%.The levels of Mac-2Bp,Hcy and Fuc-Hpt is not statistically different between the NASH group and the control group(p>0.05).Conclusions:1.Obesity,diabetes,hyperlipidemia,hyperuricemia are related to NAFLD,BMI increased with with the increased of fatty liver disease severity.HDL-C levels were negative correlation with NAFLD and the fatty liver disease severity.2.Serum levels of Mac-2Bp in NASH is low.therefore,Serum Mac-2Bp level can be used as a predictive factor to evaluate NAFLD,as well as a noninvasive diagnosis index for NAFLD.