Abstract
Aim:In this study, we aimed to investigate the relationship between the histological fibrosis stage of nonalcoholic fatty liver disease (NAFLD) and serum connective tissue growth factor (CTGF) to determine the usefulness of this relationship in clinical practice.Methods:Serum samples were collected from 51 patients with biopsy-proven NAFLD and 28 healthy controls, and serum levels of CTGF were assayed by ELISA.Results:Levels of CTGF were significantly higher in patients with NAFLD compared with controls (P= 0.001). The serum CTGF levels were significantly increased, that correlated with histological fibrosis stage, in patients with NAFLD [in patients with no fibrosis (stage 0) 308.2 ± 142.9, with mild fibrosis (stage 1–2) 519.9±375.2 and with advanced fibrosis (stage 3–4) 1353.2 ± 610 ng/l,P< 0.001]. Also serum level of CTGF was found as an independent predictor of histological fibrosis stage in patients with NAFLD (β= 0.662,t= 5.6,P< 0.001). The area under the ROC curve was estimated 0.931 to separate patients with severe fibrosis from patients with other fibrotic stages.Conclusion:Serum levels of CTGF may be a clinical utility for distinguishing NAFLD patients with and without advanced fibrosis.
Highlights
Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome and is one of the most common causes of chronic liver disease worldwide [1,2]
In the present study, (a) serum connective tissue growth factor (CTGF) was significantly higher in patients with NAFLD compared with controls, (b) serum CTGF was significantly higher in patients with severe fibrosis compared with no or mild fibrosis stages, (c) there was a significant correlation between serum CTGF levels and nonalcoholic steatohepatitis (NASH) scores and fibrosis stages in patient with NAFLD and (d) serum CTGF level was found to be an independent predictor of histological fibrosis stage in patients with NAFLD
It is shown that CTGF expressed by hepatocytes had a stimulating effect together with the transforming growth factor beta (TGF-β) which is an important mediator of liver fibrogenesis on the formation of extracellular matrix by hepatic stellate cells [22]
Summary
Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome and is one of the most common causes of chronic liver disease worldwide [1,2]. The disease is divided into two sub-groups as simple steatosis and nonalcoholic steatohepatitis (NASH). It is well known that the NASH may progress to advanced fibrotic disease and lead to cirrhosis. In this aspect, identifying advanced fibrosis and distinguishing NAFLD as simple steatosis or NASH are clinically important. The liver biopsy, as an invasive method, is still the gold standard for diagnosis of NAFLD and differentiation of NASH. Y. Colak et al / NAFLD and connective tissue growth factor
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