BACKGROUND & AIMS Tsukushi (TSK) is a recently identified hepatokine and we aimed to investigate the association between systemic TSK and the severity of non-alcoholic fatty liver disease (NAFLD) in subjects with and without type 2 diabetes mellitus (DM). METHODS 393 DM and 289 without DM individuals were recruited for transient elastography assessment to determine liver steatosis and fibrosis. Serum TSK was measured by enzyme-linked immunosorbent assay (ELISA) method. The presence of NAFLD was defined as controlled attenuation parameter (CAP) ≥ 248 dB/m. RESULTS NAFLD was present in 276 (70.2%) and 129 (44.6%) subjects with and without DM respectively, and they had higher serum TSK levels than those without NAFLD [DM group: 91.0 ng/ml (61.7-133.8) vs 82.5 (60.9-118.5), p < 0.01 respectively; without DM group: 97.1 ng/ml (69.3-148.6) vs 80.8 (53.4-111.6) respectively, p < 0.01]. Univariate analysis showed that serum TSK significantly correlated with the degree of steatosis and fibrosis both in subjects with and without DM. On multivariable regression analysis, only liver stiffness (LS) and estimated glomerular filtration rate (eGFR) were significant determinants of TSK level and the relationship was independent of diabetes and serum adiponectin. Out of 405 subjects with NAFLD, 49 had either advanced fibrosis or cirrhosis. The area under receiver operating characteristic (AUROC) curve of serum TSK to indicate advanced fibrosis or cirrhosis was 0.70 (95% CI 0.62-0.77) which was significantly better than that of fibrosis-4 (FIB-4) index, 0.64 (95% CI 0.55-0.72), p < 0.05. CONCLUSIONS Serum TSK levels were increased in subjects with NAFLD and reflected the severity of liver fibrosis.

中文翻译：

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血清 Tsukushi 水平与肝纤维化的严重程度相关，与 2 型糖尿病无关。

背景与目的 Tsukushi (TSK) 是最近发现的一种肝因子，我们旨在研究患有或不患有 2 型糖尿病 (DM) 的受试者中全身性 TSK 与非酒精性脂肪肝病 (NAFLD) 严重程度之间的关联。方法 招募 393 名糖尿病患者和 289 名非糖尿病患者进行瞬时弹性成像评估，以确定肝脏脂肪变性和纤维化。采用酶联免疫吸附测定（ELISA）法测定血清TSK。NAFLD 的存在定义为受控衰减参数 (CAP) ≥ 248 dB/m。结果 患有 DM 和不患有 DM 的受试者分别有 276 名（70.2%）和 129 名（44.6%）存在 NAFLD，他们的血清 TSK 水平高于无 NAFLD 的受试者[DM 组：91.0 ng/ml（61.7-133.8） vs 82.5（ 60.9-118.5), p < 0.01 分别; 无 DM 组：分别为 97.1 ng/ml (69.3-148.6) vs 80.8 (53.4-111.6)，p < 0.01]。单变量分析显示，无论是否患有糖尿病，血清 TSK 与脂肪变性和纤维化程度均显着相关。在多变量回归分析中，只有肝脏硬度（LS）和估计肾小球滤过率（eGFR）是 TSK 水平的显着决定因素，并且这种关系与糖尿病和血清脂联素无关。在 405 名 NAFLD 受试者中，49 名患有晚期纤维化或肝硬化。血清 TSK 指示晚期纤维化或肝硬化的受试者工作特征曲线下面积 (AUROC) 为 0.70 (95% CI 0.62-0.77)，明显优于纤维化 4 (FIB-4) 指数 0.64 (95%) CI 0.55-0.72），p < 0.05。结论 NAFLD 患者血清 TSK 水平升高，反映了肝纤维化的严重程度。