Abstract: Objective The aim of this study was to explore the clinical implication of serum cytokeratin 18 fragment M30 (CK18-M30) and fibroblast growth factor-21 (FGF-21) levels in patients with non-alcoholic steatohepatitis (NASH). Methods 85 patients with NASH and 5 healthy individuals were recruited in our hospital between October 2018 and October 2020, and liver biopsies were performed in patients with NASH. Serum CK18-M30 and FGF-21 levels were detected by ELISA. The blood glucose-lipid metabolism indexes, such as fasting blood glucose (FPG), insulin (FIN), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triacylglycerol (TG)], and homeostasis model assessment of insulin resistance (HOMA-IR) were detected by full-automatic biochemical analyzer. Results Serum FIN, FPG, TC, TG, HOMA-IR, LDL-C, CK18-M30 and FGF-21 levels in patients were (17.1±4.9)mIU/L,(5.4±1.4)mmol/L, (5.4±0.9)mmol/L, (2.0±0.6)mmol/L, (1.4±0.2), (3.6±0.6)mmol/L, (96.4±14.6)U/L and (283.6±79.2)pg/mL, all significantly higher than [(13.1±1.1)mIU/L, (4.9±0.9)mmol/L, (4.8±0.7)mmol/L, (1.5±0.2)mmol/L, (1.3±0.1), (2.6±0.5)mmol/L, (70.3±8.7)U/L and (155.3±60.4)pg/mL, respectively, P＜0.05]; serum FIN, FPG, TC, TG, CK18-M30 and FGF-21 levels in 48 patients with moderate to severe NASH were (18.4±43.9)mIU/L, (5.7±1.3)mmol/L, (5.6±0.9)mmol/L, (2.1±0.5)mmol/L, (101.9±13.9)U/L and (299.5±77.4)pg/mL, all significantly higher than [(15.3±4.2)mIU/L, (5.1±1.2)mmol/L, (4.9±0.8)mmol/L, (1.8±0.6)mmol/L, (89.3±12.5)U/L and (263.0±69.8)pg/mL, respectively, P＜0.05] in 37 patients with mild NASH; serum TC, TG, HOMA-IR, CK18-M30 and FGF-21 levels in 35 NASH patients with concomitant diseases such as hyperlipidemia, diabetes and high blood pressure, were (5.8±0.9)mmol/L, (2.2±0.5)mmol/L, (1.5±0.6), (101.7±14.3)U/L and (306.9±63.1)pg/mL, all significantly higher than [(5.1±0.8)mmol/L, (1.9±0.6)mmol/L, (1.3±0.5), (92.6±13.1)U/L and (267.2±77.9)pg/mL, respectively, all P＜0.05] in those without. Conclusion Serum CK18-M30 and FGF-21 levels increase in patients with NASH, which is correlated to the disease severity and concomitant hyperlipidemia, higher blood pressure and diabetes. The detection of serum CK18-M30 and FGF-21 levels might be helpful in assessing the diagnosis and management.

Key words: Non-alcoholic steatohepatitis, Cytokeratin 18, Fibroblast growth factor-21, Insulin resistance