BIOCHEMICAL MARKERS OF LIPID PEROXIDATION AND FIBROSIS IN PATIENTS WITH SIMPLE STEATOSIS AS COMPARED TO PATIENTS WITH NONALCOHOLIC STEATOHEPATITIS

Abstract

Purpose: Nonalcoholic fatty liver disease (NAFLD) is an all inclusive term that encompasses both simple steatosis and nonalcoholic steatohepatitis (NASH). To date, differentiation of these two entities requires histopatho-logic evaluation. The purpose of this study was to determine if there is a reliable biochemical assay that could differentiate patients with steatosis from patients with steatohepatitis. Methods: Forty subjects with NAFLD obtained from our liver biopsy database were enrolled. Twenty subjects had simple steatosis and 20 had histopathologic evidence of NASH. Demographic data including age, gender, body mass index, and presence of hypertension and diabetes was obtained. Laboratory data including fasting glucose, fasting insulin, calculated QUICKI, ALT, AST, LDL, triglycerides, and HgbA1C were documented. Fasting urinary 8-epi-PGF2α and fasting serum levels of transforming growth factor beta (TGFβ), adiponectin, and hyaluronic acid were measured and compared between the two groups. Results: Clinical characteristics of the groups are presented below. No significant difference between the two groups with respect to levels of urinary 8-epi-PGF2?, TGF?, or adiponectin was found. We did find significantly higher levels of hyaluronic acid in the NASH group (p = 0.026). In a subgroup analysis of the NASH group by histologic stage, there was no difference between stage 1 or 2 fibrosis and those subjects with steatosis. However, there were significantly higher levels of hyaluronic acid in subjects with stage 3 or 4 fibrosis compared to subjects with steatosis or those with NASH stage 1 or2(p <0.001). Conclusions: Hyaluronic acid levels are significantly higher among subjects with NASH and advanced stages of fibrosis compared with subjects with only simple steatosis. This finding may allow for development of a non-invasive model using clinical and biochemical data to diagnose subjects with advanced stages of NASH without the use of liver biopsy. Further analysis with larger subject enrollment seems warranted.Table: Clinical Characteristics