Abnormal fucosylation of alpha-fetoprotein in patients with non-alcoholic steatohepatitis.

AIM Non-alcoholic steatohepatitis (NASH) is a risk factor for non-virus-related hepatocellular carcinoma, which is increasing in prevalence. The aim of this study was to clarify the clinical application of fucosylated alpha-fetoprotein (AFP-L3) in the process of non-alcoholic fatty liver disease development. METHODS Serum samples from 115 diabetes mellitus (DM), 36 non-alcoholic fatty liver (NAFL), and 119 NASH patients were analyzed for AFP-L3 expression using raw data of a micro total analysis system. These data were then compared with the clinical characteristics of the patients. Validation study was also performed with 55 samples (17NAFL and 38 NASH). RESULTS Trace amounts of AFP-L3 were detected in 3.5%, 16.7%, and 58.0% of patients with DM, NAFL, and NASH, respectively. The odds ratio of AFP-L3 positivity for the diagnosis of NASH in multivariate analysis was 9.81 (95% confidence interval 3.77-25.5). The rates in patients without fibrosis, with stage 1, stage 2, stage 3, and stage 4 fibrosis were 14.7%, 31.3%, 63.0%, 86.2% and 100%, respectively. The rates were significantly increased according to the advancement of liver fibrosis (p<0.001); however, no difference in the positive rate of AFP-L3 was observed between patients with and without fatty livers and between patients with normal and abnormal transaminase. The same relationship was also observed in the validation cohort. CONCLUSION Abnormal fucosylation of AFP occurred in patients with NASH, so it may be useful for the screening of NASH in patients with DM, as well as for the differential diagnosis of NASH and the evaluation of fibrosis. This article is protected by copyright. All rights reserved.