Usefulness of collagen type IV in the detection of significant liver fibrosis in nonalcoholic fatty liver disease.

INTRODUCTION/AIMS: Liver fibrosis assessment is a key issue in the evaluation of nonalcoholic fatty liver disease (NAFLD) patients. In the present study, we aimed to validate a noninvasive marker panel to assess significant and advanced fibrosis in these patients. METHOD: 126 biopsy-proven NAFLD patients were included. NAFLD diagnosis was based on histological criteria. Fibrosis stages were determined according to NASH-Clinical Research Network criteria. Clinical and laboratorial data were collected during the interval of three months before or after liver biopsy. Histological fibrosis stages were classified as significant fibrosis (F2-F4) and advanced fibrosis (F3-F4). Five serum biomarkers [hyaluronic acid (HA), collagen type IV (cIV), procollagen type III (PC III), laminin (LN) and cholylglycine (CG)] were assessed by chemiluminescence immunoassays. RESULTS: Most patients were female (61.61%), mean age: 55.7 ±â€¯9.13 years old and mean BMI was 32.1 ±â€¯5.9 kg/m2. Prevalence of diabetes, dyslipidemia, arterial hypertension, and metabolic syndrome was 68.75%, 82.29%, 63.54% and 81.05%, respectively. Patients with cIV above 30 ng/mL had a 5.57-times (IC: 1.86-16.69) the chance of having significant fibrosis and 7.61-times (IC: 2.27-25.54) the chance of having advanced fibrosis versus patients with values below 30 ng/mL. HA, PC III, LN and CG did not detect the presence of significant and advanced fibrosis. The AUROC of clV for detection of significant (0.718) and advanced fibrosis (0.791) was better than that of other serum biomarkers. CONCLUSION: Type 4 collagen could predict the presence of significant and advanced fibrosis in NAFLD patients and it would be a useful tool in routine clinical practice.

Determinación de ceruloplasmina y cobre sérico en la colestasia intrahepatica del embarazo / Serum determination of ceruloplasmina and copper in pregnant women with intrahepatic cholestasis

Se realizan determinaciones e colilglicina (CG), ceruloplasmina (Cp) y cobre (Cu) séricos en 30 mujeres sanas no embarazadas; en 74 embarazadas sanas, y en 57 embarazadas con diagnóstico clínico de colestasia intrahepática del embarazo (CIE). A estas últimas se las clasifica de acuerdo con los niveles séricos de CG. Se concluye que en las embarazadas con diagnóstico clínico de CIE,pero con niveles de CG en ayunas y después de ingestión de grasas normales (= grupo uno), los niveles de Cp y de Cu no presentan diferencias con respecto al grupo de embarazadas normales. El grupo tres, con niveles de CG elevados, señala valores significativamente mayores que las embarazadas normales y el grupo uno. Se llama la atención sobre la utilidad de la determinación de CG en el diagnóstico de la CIE. Se omite en la casuística el grupo dos, que está reducido a sólo dos pacientes. Finalmente, los autores declaran que están estudiando un índice bioquímico para detectar el sufrimiento fetal en la colestasia hepática

Niveles séricos de colilglicina en ayunas y post-ingesta grasa, en grupo control y en pacientes con colestasia intrahepática del embarazo / Serum levels of cholylglycine in fasting and after meals fats in control group and in patients with intrahepatic cholestasis of pregnancy

Se realizan determinaciones de colilglicina (CG) en ayunas y después de la prueba de sobrecarga de grasa (PSG), en embarazadas normales y en enfermas con diagnóstico de colestasia intrahepática del embarazo (CIE). En el grupo de embarazo normal el valor promedio de CG en ayunas fue 0,193 ug/ml, y después de la referida prueba (PSG), de 0,206 ug/ml, siendo el valor máximo normal, 0,7 ug/ml. En los casos de CIE los cálculos de CG basales y después de la referida prueba permitió dividir a las pacientes de tres grupos, a saber: grupo A, con niveles basales y posprandiales elevados; grupo B, con niveles basales normales y posprandiales elevados, y grupo C, con diagnóstico de CIE y valores previos alterados, en el cual sucesivas ensayos en ayuas pueden ser normales, esto es, "negativos falsos", pero persistiendo alteradas las pruebas posprandiales. Se observan diferencias significativas al comparar los valores de CG del grupo C (p <0,001) con el grupo control y con el grupo A. El valor previo máximo de las pacientes con CIE, tanto nivel previo como posprandial fue sobre 50 ug/ml, esto es, más de 250 veces sobre el valor promedio del grupo control (en ayunas, 0,193 ug/ml y posprandial (PSG) 0,206 ug/ml)

[Determination of cholic and sulfolithocholic acids in various hepatopathies]. / Determinación de los ácidos cólico y sulfolitoglicocólico en diferentes hepatopatías.

The conjugated cholic acid (glycocholic acid) (GC) in the serum and the conjugated sulfolithocholic acid (sulfolithoglycocholic acid (SLGC) in 35 aggressive chronic hepatitis (HCA), 22 cirrhosis, 11 primary biliary cirrhosis (CBP), 11 pruritus of pregnancy and in 20 normal controls were determined. The control group revealed a mean value of GC of 21 micrograms % with a dispersion of +/- 14 micrograms % and for SLGC of 36 micrograms % with a dispersion of +/- 9 micrograms %. The frequency of the alteration of GC and SLGC in the cases of chronic hepatitis was low (14% and 9%) as well as in the cirrhosis (23% and 14%). In the pruritus of pregnancy the values reached 64% and 45%. On the other hand, the values were significantly elevated in CBP (100% and 90%) (p.001 and p.006). The absolute values in the various pathologies revealed mean values which were different but with a very wide dispersion that prevented us from seeing any relation between those absolute values and the different diseases. The alteration in the metabolism of biliary acids in the hepatic pathology was manifested by the postprandial determination of GC and SLGC in 20 HCA in whom the frequency of abnormal values rose from 14% and 9% on fasting to 60% and 45% prandially.

Serum bile acid response to a test meal stimulus: a sensitive test of ileal function.

We assessed ileal functional integrity, as reflected in the capacity to reabsorb the bile acid, cholylglycine, by sequential measurement of postprandial serum levels of this compound. A consistent increase in cholylglycine concentration (mean +/- SEM, peak above fasting baseline = 1.86 +/- 0.14 microM) occurred in eight normal children. Five patients with ileal resection and two with primary bile acid malabsorption had a minimal postprandial increase (0.27 +/- 0.08 microM; P less than 0.005 vs controls) and excess bile acid loss in feces. Similarly, in seven patients with Crohn disease involving the ileum the postprandial increase (0.38 +/- 0.06) was less than controls (P less than 0.001). In eight patients with cystic fibrosis, the administration of pancreatic enzymes normalized the blunted response demonstrated when enzymatic therapy was interrupted suggesting an intact ileal active transport mechanism. Meal-stimulated response of serum cholylglycine concentration is a sensitive indicator of altered ileal integrity and bile acid malabsorption due to ileal resection, inflammation, or dysfunction.