title: Diagnostic value of serum prolidase enzyme activity to predict the liver histological lesions in non-alcoholic fatty liver disease: a surrogate marker to distinguish steatohepatitis from simple steatosis.
abstract: Determination of the liver histological lesions with noninvasive tests is an important part of the diagnostic work-up of patients with non-alcoholic fatty liver disease (NAFLD). We aimed to determine the predictive value of noninvasive biochemical markers, serum prolidase enzyme activity (SPEA), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and AST/ALT ratio for the liver histological lesions. Fifty-four liver biopsy-proven patients with NAFLD and 37 healthy controls were enrolled to the study. The diagnostic accuracies of biochemical markers were evaluated by receiver operating characteristic (ROC) curves and multiple linear regression analysis to predict the degree of fatty infiltration, lobular inflammation, NAFLD activity score, and stage of fibrosis. The SPEA of patients with steatohepatitis is significantly increased compared with the patients with simple steatosis and controls (1,338 [1,138-1,624] U/l; 974 [768-1,160] U/l; 972 [862-1,122] U/l, shown as median [25th-75th interquartile range], respectively, P < 0.0001). SPEA was positively correlated with the grade of liver fatty infiltration, lobular inflammation and NAFLD activity score, and stage of fibrosis, (r = 0.377, P < 0.005; r = 0.443, P < 0.001; r = 0.457, P < 0.001; r = 0.321, P < 0.018, respectively). SPEA was the best predictor for distinguishing steatohepatitis from simple steatosis according to the ROC analysis (area under the curve [AUC]: 0.85). Multivariate analysis revealed that the most useful single test for predicting lobular inflammation, NAFLD activity score, and fibrosis was SPEA, and for predicting the fatty infiltration, it was ALT (P < 0.00001, P < 0.001, P < 0.0001, P < 0.0001, respectively). This study demonstrated that SPEA can accurately predict the degree and stage of all histological lesions in NAFLD. It could be helpful for distinguishing steatohepatitis from simple steatosis and reducing the need for liver biopsy in the majority of patients with NAFLD.
authors.affiliation: Department of Biochemistry and Clinical Biochemistry, Ardahan Military Hospital, Ardahan, Turkey. mdkayadibi@yahoo.com
authors.forename: Huseyin
authors.initials: H
authors.lastname: Kayadibi
authors.forename: Mustafa
authors.initials: M
authors.lastname: Gültepe
authors.forename: Bulent
authors.initials: B
authors.lastname: Yasar
authors.forename: Ali T
authors.initials: AT
authors.lastname: Ince
authors.forename: Omer
authors.initials: O
authors.lastname: Ozcan
authors.forename: Osman M
authors.initials: OM
authors.lastname: Ipcioglu
authors.forename: Oya O
authors.initials: OO
authors.lastname: Kurdas
authors.forename: Burhanettin
authors.initials: B
authors.lastname: Bolat
authors.forename: Yusuf Z
authors.initials: YZ
authors.lastname: Benek
authors.forename: Hakan
authors.initials: H
authors.lastname: Guveli
authors.forename: Sacide
authors.initials: S
authors.lastname: Atalay
authors.forename: Selvinaz
authors.initials: S
authors.lastname: Ozkara
authors.forename: Ozcan
authors.initials: O
authors.lastname: Keskin
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000378:metabolism; D001219:Aspartate Aminotransferases / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D016022:Case-Control Studies; D003937:Diagnosis, Differential; D004150:Dipeptidases / Q000097:blood*; D005234:Fatty Liver / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006505:Hepatitis / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D016014:Linear Models; D008099:Liver / Q000201:enzymology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D004150:Dipeptidases; C022449:proline dipeptidase