Positive Pattern Recognition System Using Alanine Aminotransferase, Type IV Collagen 7s, and E Value (Liver Stiffness) for the Diagnosis of Nonalcoholic Steatohepatitis Based on Natural History

Abstract

Introduction: The use of a simple diagnostic system for nonalcoholic fatty liver disease (NAFLD) instead of a biopsy is expected. We investigated a positive pattern recognition system for the evaluation of nonalcoholic fatty liver (NAFL) and the stages of nonalcoholic steatohepatitis (NASH). Methods: A total of 68 Japanese patients with biopsy-confirmed NAFLD were enrolled. Serological biomarkers and medical imaging markers were investigated to determine candidate markers. The markers were statistically evaluated, and the patients were distributed to pattern combinations. Results: We selected three markers based on natural history and set the critical values: alanine aminotransferase/ALT (persistent ≧ 44 IU/L) as a marker for hepatitis, type IV collagen 7S (≧5.1 ng/mL) for fibrosis, and E value (≧5.5 kPa) for stiffness. After evaluation of statistical accuracies, every patient was classified into their combination patterns. Comparing the relationships between histological classifications and positive patterns, the patients with NAFL were mainly distributed in pattern (ALT, type IV collagen, E value: −, −, −), those with NASH stage 0-1 in (+, −, +), those with NASH stage 2-3 in (+, +, +), and those with NASH stage 4 in (−, +, +). Conclusions: The positive patters changed with the NAFL and NASH conditions. Our results indicated a correlation between the positive patterns using three markers and the histological results. The positive pattern recognition system based on natural history is useful for the differential diagnosis of NAFLD and for the evaluation of the severity of fibrosis in patients with NASH.

Roles of hepatic stellate cells in NAFLD: From the perspective of inflammation and fibrosis

“…Non-alcoholic fatty liver disease (NAFLD), including two subtypes of non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH), is increasingly prevalent and represents a growing challenge in terms of prevention and treatment ( Chalasani et al, 2018 ). For defining NAFLD, there must be evidence of hepatic steatosis, either by imaging or histology, and lack of secondary causes of hepatic fat accumulation such as significant alcohol consumption, long-term use of a steatogenic medication, or monogenic hereditary disorders ( Tsujisaki et al, 2022 ). NAFL is a nonprogressive form of NAFLD in which fat accumulates in the liver but little or no inflammation or liver damage occurs.…”