薬理と治療

Abstract

Background We have reported the elevation of serum advanced glycation endproducts（AGEs）in nonalcoholic steatohepatitis（NASH）, and have elucidated the importance of AGEs for the liver fibrogenesis in vitro. In this study, we explored the clinical usefulness of serum AGEs and soluble receptor for AGEs（sRAGE）in NASH. Methods Sixty－seven patients with biopsy proven NASH were enrolled. Clinical parameters and follow－up biopsies were examined before and after therapies（Therapies were carried out based upon the metabolic factors）. Serum AGEs and sRAGE were examined before therapies. Patients were divided into two groups based upon the changes of nonalcoholic fatty liver disease activity score（NAS）or fibrosis stage, respectively. Deteriorated groups were defined as NAS or fibrosis stage increased, and others not. The clinical parameters were compared between these groups. Results Follow－up biopsies were obtained in thirty－eight patients. sRAGE levels before therapies were significantly lower in deteriorated group of NAS compared with the other group. In deteriorated group of fibrosis stage, ferritin levels were significantly higher before and after therapies and further, post－therapy ALT levels were significantly higher than the other group. Changes of NAS were correlated with sRAGE before therapies, changes of ALT, and of BMI. Changes of fibrosis stage were correlated with AGEs and ferritin before therapies, and changes of BMI. Lower levels of sRAGE with higher levels of AGEs were the determinant of fibrosis deterioration. Conclusions AGEs and sRAGE levels might be useful parameters in determining the histological outcome in NASH.