Zusammenfassung
HINTERGRUND: Spezifische Marker für die Differenzierung der nicht alkoholischen (NASH) von der alkoholischen Steatohepatitis (ASH) fehlen. Wir untersuchten den Stellenwert von routinemäßig eingesetzten Laborparametern in der Differenzierung von NASH von ASH. METHODEN: Leberbiopsien, die über einen Zeitraum von 10 Jahren in unserem Krankenhaus durchgeführt wurden, wurden nochmals durchgesehen, 95 Patienten mit Steatohepatitis identifiziert und Ihre Daten zum Zeitpunkt der Biopsie reevaluiert. Basierend auf Ergebnisse der Leberbiopsie und Anamnese von Alkoholkonsum (< 140 g/Woche) wurde die Diagnose NASH oder ASH zugeteilt (andere Lebererkrankungen ausgeschlossen). Die Analyse erfolgte mittels logistischer Regression. ERGEBNISSE: NASH wurde bei 58 (61%; 30 w) und ASH bei 37 (39%; 9 w) Patienten diagnostiziert. Höhergradige Fibrose (59% vs. 19%, p < 0,0001) und AST/ALT Ratio > 1 (54,1% vs 20,7%, p = 0,0008) waren häufiger bei ASH zu finden. MCV war bei 53% der ASH Patienten erhöht and bei allen NASH Patienten (p < 0,0001) im Normbereich. Die multivariate Analyse identifizierte MCV (p = 0,0013), AST/ALT Ratio (p = 0,011) und Geschlecht (p = 0.0029) als die relevanten Regressoren (aROC = 0,92). AST/ALT Ratio (p < 0,0001) and Alter (p = 0,00049) waren unabhängige Prädiktoren für höhergradige Fibrose. Die Unterschiede bei MCV waren deutlicher bei höhergradiger Fibrose. SCHLUSSFOLGERUNGEN: Höheres MCV und AST/ALT Ratio bei ASH reflektieren den Schweregrad der zugrunde liegenden Lebererkrankung und können nicht zur Unterscheidung von ASH von NASH beitragen. Statt dessen könnten sich diese Marker als nützlich für die Patientenselektion für Leberbiopsie und in der Therapieplanung erweisen.
Summary
BACKGROUND/AIMS: Specific markers for differentiation of nonalcoholic (NASH) from alcoholic steatohepatitis (ASH) are lacking. We investigated the role of routine laboratory parameters in distinguishing NASH from ASH. METHODS: Liver biopsies performed at our hospital over a 10-year period were reviewed, 95 patients with steatohepatitis identified and their data prior to biopsy reevaluated. The diagnosis NASH or ASH was assigned (other liver diseases excluded) on the basis of the biopsy and history of alcohol consumption (< 140 g/week). Logistic regression models were used for analysis. RESULTS: NASH was diagnosed in 58 patients (61%; 30 f) and ASH in 37 (39%; 9 f). High-grade fibrosis (59% vs. 19%, P < 0.0001) and an AST/ALT ratio > 1 (54.1% vs 20.7%, P = 0.0008) were more common in ASH. The MCV was elevated in 53% of ASH patients and normal in all NASH patients (P < 0.0001). Multivariate analysis identified the MCV (P = 0.0013), the AST/ALT ratio (P = 0.011) and sex (P = 0.0029) as relevant regressors (aROC = 0.92). The AST/ALT ratio (P < 0.0001) and age (P = 0.00049) were independent predictors of high-grade fibrosis. Differences in MCV were more marked in high-grade fibrosis. CONCLUSIONS: Higher MCVs and AST/ALT ratios in ASH reflect the severity of underlying liver disease and do not differentiate NASH from ASH. Instead, these biomarkers might prove useful in guiding selection of patients for liver biopsy and in targeting therapy.
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Kazemi-Shirazi, L., Veloso, M., Frommlet, F. et al. Differentiation of nonalcoholic from alcoholic steatohepatitis: are routine laboratory markers useful?. Wien Klin Wochenschr 120, 25–30 (2008). https://doi.org/10.1007/s00508-007-0921-1
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DOI: https://doi.org/10.1007/s00508-007-0921-1