Easuring serum sCD14 levels may be very useful to predict the progression of NASH and could become a routine test for the assessment in NAFLD patients for predicting NASH progression instead of invasive liver biopsy. Therefore, the purpose of this study was to investigate the clinical usefulness of measuring serum sCD14 levels as a biomarker for assessing the severity of NASH.noassay. The other parameters were measured using a conventional automated analyzer. Insulin resistance was calculated using the modified homeostasis model assessment of insulin resistance (HOMA-IR) equation: HOMA-IR = fasting insulin (mU/ml) 6 plasma glucose (mg/dl)/405, as originally reported by Matthews et al [19].Anthropometry and Abdominal Fat DistributionAbdominal fat distribution was determined by computed tomography (CT) with the subjects in a supine position, as previously described [20]. Subcutaneous fat area and intraabdominal visceral fat area were measured at the level of the umbilicus using a standardized method based on CT values. A histogram representing the fat tissue was computed based on the mean attenuation 62 standard deviations (SDs).Measurement of Serum sCD14 LevelsSerum sCD14 levels were measured by a sandwich enzymelinked immunosorbent assay (R D Systems, Abingdon, UK). The intra- and interassay coefficients of variation stated by the manufacturers were ,7 for all assays.Histological AssessmentWe performed liver biopsies with an 18G needle biopsy kit using a standard protocol. Two specimens were obtained to provide a sufficient sample size for analysis and to reduce histological errors. Liver biopsy samples were excised and embedded in paraffin for histological analysis. The presence of collagen, as an index of lesion fibrosis, was examined in Masson’s trichrome-stained preparations. Histological assessment of liver was performed by two pathologists according to criteria proposed by Sanyal and Brunt et al. [21?2]. Macrovesicular steatosis affecting at least 5 of the hepatocytes was observed in all the cases of NAFLD, and the patients were 52232-67-4 site classified as not having steatohepatitis (not NASH) or having steatohepatitis (NASH). In addition to steatosis, the minimum criteria for the diagnosis of steatohepatitis include the presence of lobular inflammation, ballooning of cells and perisinusoidal/pericellular fibrosis in zone 3 of the hepatic acini. Steatosis was graded as ,5 (grade 0), 5?3 (grade 1), 33?6 (grade 2), and .66 (grade 3). Lobular inflammation was graded according to the number of inflammatory foci per field of view at a magnification of 2006, as follows: no foci = 0, ,2 foci per field = 1, 2? foci per field = 2, and .4 foci per field = 3. Hepatocellular ballooning was graded as none (grade 0), few ballooning cells (grade 1), and many balloon cells (grade 2). The pathologists also performed NAFLD activity scoring based on Kleiner et al [23] to evaluate disease activity, but the actual diagnosis was not based on NAFLD activity score (NAS) [21]. The NAS was calculated as the unweighted sum of the scores for steatosis, lobular inflammation, and hepatocellular ballooning based on the Nonalcoholic Steatohepatitis Clinical Research Network methodology. The severity of fibrosis was 58-49-1 scored according to the method of Brunt [22]. Subjects with NASHassociated cirrhosis were defined according to a previously proposed clinicopathological classification [24].Patients and Methods SubjectsThe study population consisted of 113 patients with biops.Easuring serum sCD14 levels may be very useful to predict the progression of NASH and could become a routine test for the assessment in NAFLD patients for predicting NASH progression instead of invasive liver biopsy. Therefore, the purpose of this study was to investigate the clinical usefulness of measuring serum sCD14 levels as a biomarker for assessing the severity of NASH.noassay. The other parameters were measured using a conventional automated analyzer. Insulin resistance was calculated using the modified homeostasis model assessment of insulin resistance (HOMA-IR) equation: HOMA-IR = fasting insulin (mU/ml) 6 plasma glucose (mg/dl)/405, as originally reported by Matthews et al [19].Anthropometry and Abdominal Fat DistributionAbdominal fat distribution was determined by computed tomography (CT) with the subjects in a supine position, as previously described [20]. Subcutaneous fat area and intraabdominal visceral fat area were measured at the level of the umbilicus using a standardized method based on CT values. A histogram representing the fat tissue was computed based on the mean attenuation 62 standard deviations (SDs).Measurement of Serum sCD14 LevelsSerum sCD14 levels were measured by a sandwich enzymelinked immunosorbent assay (R D Systems, Abingdon, UK). The intra- and interassay coefficients of variation stated by the manufacturers were ,7 for all assays.Histological AssessmentWe performed liver biopsies with an 18G needle biopsy kit using a standard protocol. Two specimens were obtained to provide a sufficient sample size for analysis and to reduce histological errors. Liver biopsy samples were excised and embedded in paraffin for histological analysis. The presence of collagen, as an index of lesion fibrosis, was examined in Masson’s trichrome-stained preparations. Histological assessment of liver was performed by two pathologists according to criteria proposed by Sanyal and Brunt et al. [21?2]. Macrovesicular steatosis affecting at least 5 of the hepatocytes was observed in all the cases of NAFLD, and the patients were classified as not having steatohepatitis (not NASH) or having steatohepatitis (NASH). In addition to steatosis, the minimum criteria for the diagnosis of steatohepatitis include the presence of lobular inflammation, ballooning of cells and perisinusoidal/pericellular fibrosis in zone 3 of the hepatic acini. Steatosis was graded as ,5 (grade 0), 5?3 (grade 1), 33?6 (grade 2), and .66 (grade 3). Lobular inflammation was graded according to the number of inflammatory foci per field of view at a magnification of 2006, as follows: no foci = 0, ,2 foci per field = 1, 2? foci per field = 2, and .4 foci per field = 3. Hepatocellular ballooning was graded as none (grade 0), few ballooning cells (grade 1), and many balloon cells (grade 2). The pathologists also performed NAFLD activity scoring based on Kleiner et al [23] to evaluate disease activity, but the actual diagnosis was not based on NAFLD activity score (NAS) [21]. The NAS was calculated as the unweighted sum of the scores for steatosis, lobular inflammation, and hepatocellular ballooning based on the Nonalcoholic Steatohepatitis Clinical Research Network methodology. The severity of fibrosis was scored according to the method of Brunt [22]. Subjects with NASHassociated cirrhosis were defined according to a previously proposed clinicopathological classification [24].Patients and Methods SubjectsThe study population consisted of 113 patients with biops.
