臨牀消化器内科 Vol.33 No.13(2-4)


特集名 肝線維化―診断を超えて
題名 肝線維化の非侵襲的評価法 (4) バイオマーカーによる肝線維化診断
発刊年月 2018年 12月
著者 朝比奈 靖浩 東京医科歯科大学消化器内科・肝臓病態制御学講座
【 要旨 】 肝線維化の進展度を正確かつ経時的に評価することは診療上きわめて重要であり,繰り返し測定可能な血清バイオマーカーの果たす役割は大きい.肝線維化は肝における線維合成(fibrogenesis)と線維分解(fibrolysis)との動的なバランスによって形成されており,これらの過程で結合組織の構成成分が血中に流出してくる.従来から,これらに関連した血中濃度の測定が血清線維化マーカーとして用いられており,おもなものとしてヒアルロン酸,Ⅳ型コラーゲン,Ⅳ型コラーゲン7S,Ⅲ型プロコラーゲンN末端ペプチドが挙げられ,すでに保険適用がある.一方,最近ではMac-2結合タンパク質糖鎖修飾異性体(M2BPGi)やオートタキシンといった新しいバイオマーカーも開発されており,いずれも保険適用となった.それぞれの血清線維化マーカーの特性や意義は異なり,また病因や病態によりその挙動は異なる.したがって,実臨床ではそれぞれの特性をよく理解したうえで,病態に応じた使い分けや,結果の解釈が必要である.
Theme Liver Fibrosis : Beyond the Diagnosis
Title Noninvasive Serum-based Biomarkers for Liver Fibrosis
Author Yasuhiro Asahina Department of Gastroenterology and Hepatology, Department of Liver Disease Control, Tokyo Medical and Dental University
[ Summary ] Assessment of liver fibrosis is essential for management of liver disease. Although liver biopsy is considered to be the gold standard for staging of liver fibrosis, liver biopsy is an invasive and inaccurate method with numerous drawbacks. In order to overcome these limitations, a number of noninvasive techniques have been developed for assessment of liver fibrosis. Conventionally, serum products related to liver fibrogenesis and fibrolysis, such as hyaluronic acid, type Ⅳ collagen and, P-Ⅲ-P, have been used as serum biomarkers. The Wisteria floribunda agglutinin-positive human Mac-2-binding protein (WFA+-M2BP), also called as Mac-2 binding protein glycosylation isomer (M2BPGi), was recently shown to be a liver fibrosis glycobiomarker with a unique fibrosis-related glycoalteration, This was also proposed as an risk marker for hepatocarcinogenesis. Autotaxin (ATX), which is metabolized by liver sinusoidal endothelial cells, is a newly discovered enzyme considered to be associated with liver damage and fibrosis. Each serumbased biomarker for liver fibrosis has functionally different characteristics, therefore, an understanding the functions and features of these biomarkers is important for physicians. This review will focus on currently available non-invasive serum-based biomarkers for liver fibrosis.
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