Assessment of liver stiffness in subjects affected by familial combined hyperlipidaemia with hepatic steatosis

作者：Riggio Stefania; Mamone Federica; Mandraffino Giuseppe; Maimone Sergio; Alibrandi Angela; Manti Lauretta; Saitta Carlo; Tripodi Pier Francesco; Sardo Maria Adriana; Squadrito Giovanni; Saitta Antonino^*

来源：European Journal of Clinical Investigation, 2010, 40(8): 722-728.

DOI：10.1111/j.1365-2362.2010.02323.x

• Dyslipidaemia
• fibroscan
• insulin resistance
• liver stiffness
• metabolic syndrome
• NAFLD

P>Background
Nonalcoholic fatty liver disease (NAFLD) represents a spectrum of diseases ranging from simple steatosis to nonalcoholic steatohepatitis (NASH) and is associated with familial combined hyperlipidaemia (FCHL). Currently, the invasive liver biopsy is considered as the gold standard for evaluating liver fibrosis (LF); however, liver stiffness measurement (LSM) by transient elastography (TE) trough FibroScan device may be employed to estimate LF noninvasively. The aim of this study was to evaluate the prevalence of NAFLD in FCHL subjects and to analyse LSM with TE to better identify those individuals with a potential risk of liver disease progression.
Materials and methods
Sixty subjects with FCHL (38 men, 22 women, mean age 46 center dot 4 +/- 10 center dot 9 years) were included in the study. We studied biochemical parameters including lipid profile, glucose, transaminase and insulin; blood pressure and waist circumference (WC) were measured; BMI and HOMA-index were calculated. Ultrasonography was performed to assess liver steatosis and carotid intima-media thickness (IMT). Liver fibrosis was measured by FibroScan.
Results
Patients were classified according to have no (group 0: 19%), mild (group 1: 32%) or moderate-severe (group 2: 49%) steatosis. No difference was found between group 0 and 1 concerning all study parameters. WC (P < 0 center dot 05), BMI (P < 0 center dot 05), glucose (P < 0 center dot 05), insulin (P < 0 center dot 001), HOMA-index (P < 0 center dot 001) and LSM (6 center dot 03 +/- 1 center dot 9 Kpa vs. 4 center dot 2 +/- 0 center dot 5 Kpa, P < 0 center dot 001) were significantly higher in group 2 than groups 1 and 0. Furthermore, LSM correlated with insulin (P < 0 center dot 05), glucose (P < 0 center dot 05), HOMA-index (P < 0 center dot 001), transaminase (P < 0 center dot 01) and liver steatosis (P < 0 center dot 001). Regression analysis showed that LSM (P < 0 center dot 001) and NAFLD (P < 0 center dot 01) is associated with HOMA-index; NAFLD is also associated with WC (P < 0 center dot 05).
Conclusion
Our results suggest that in FCHL subjects, HOMA-index, an insulin resistance index, is strongly associated with liver steatosis and its progression. Furthermore, in these subjects, we propose the transient elastography to identify and follow up patients for the progression of hepatic disease.

• 出版日期2010-8