Hepatobiliary surgery and nutrition · 2026
Monitoring with plasma apolipoprotein A2-isoforms can predict developing new-onset steatotic liver disease caused by pancreatic exocrine insufficiency following pancreatectomy.
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Matsushita Akira, Ono Takashi, Yoshimori Daigo, Hamaguchi Akira, Murokawa Takahiro, Ueda Junji, Shimizu Tetsuya, Kawano Yoichi, Yoshioka Masato, Kawashima Mampei, Nakamura Yoshiharu, Nagashima Kengo, Hasegawa Yuta, Kiriyama Tomonari, Takeuchi Keiko, Kashiro Ayumi, Honda Kazufumi, Yoshida Hiroshi
Аннотация
BACKGROUND: Development of new-onset steatotic liver disease (SLD) has been increasingly observed after pancreatectomy. However, the pathophysiology of post-operative SLD remains poorly understood. This study aimed to clarify the risk factors for new-onset SLD after pancreatectomy and verify the utility of monitoring plasma apolipoprotein A2-isoforms (apoA2-i) as a potentially promising biomarker for evaluating pancreatic exocrine function.
METHODS: In this retrospective study of 79 patients who underwent pancreatectomy [47 pancreaticoduodenectomies (PDs) and 32 distal pancreatectomies (DPs)] between March 2021 and March 2024, the plasma apoA2-i (AT/AT and ATQ/ATQ) levels were measured using enzyme-linked immunosorbent assay (ELISA) methods, and non-contrast-enhanced computed tomography (CT) images were manually reviewed for the diagnosis of SLD.
RESULTS: Comparing the minimum value of apoA2-AT/AT after surgery between the SLD (n=32) and non-SLD group (n=47), the apoA2-AT/AT value in the SLD group was significantly lower than that in the non-SLD group (P<0.001). The plasma apoA2-AT/AT levels <9.58 µg/mL (median of this cohort) was significantly associated with SLD (P<0.001) and an independent risk factor of SLD with both univariable [odds ratio (OR), 20.1; 95% confidence interval (CI): 6.59-74.5; P<0.001] and multivariable (OR, 13.6; 95% CI: 2.68-134.2; P=0.001) logistic regression analysis. Moreover, even when stratified by pre-onset pancrelipase administration, the cumulative incidence of SLD was significantly higher in patients with plasma apoA2-AT/AT levels <9.58 µg/mL (P<0.001). The point estimate of the area under the curve for detecting SLD of apoA2-AT/AT was 0.843.
CONCLUSIONS: SLD associated with malnutrition following pancreatectomy can be predicted using plasma apoA2-i monitoring.
METHODS: In this retrospective study of 79 patients who underwent pancreatectomy [47 pancreaticoduodenectomies (PDs) and 32 distal pancreatectomies (DPs)] between March 2021 and March 2024, the plasma apoA2-i (AT/AT and ATQ/ATQ) levels were measured using enzyme-linked immunosorbent assay (ELISA) methods, and non-contrast-enhanced computed tomography (CT) images were manually reviewed for the diagnosis of SLD.
RESULTS: Comparing the minimum value of apoA2-AT/AT after surgery between the SLD (n=32) and non-SLD group (n=47), the apoA2-AT/AT value in the SLD group was significantly lower than that in the non-SLD group (P<0.001). The plasma apoA2-AT/AT levels <9.58 µg/mL (median of this cohort) was significantly associated with SLD (P<0.001) and an independent risk factor of SLD with both univariable [odds ratio (OR), 20.1; 95% confidence interval (CI): 6.59-74.5; P<0.001] and multivariable (OR, 13.6; 95% CI: 2.68-134.2; P=0.001) logistic regression analysis. Moreover, even when stratified by pre-onset pancrelipase administration, the cumulative incidence of SLD was significantly higher in patients with plasma apoA2-AT/AT levels <9.58 µg/mL (P<0.001). The point estimate of the area under the curve for detecting SLD of apoA2-AT/AT was 0.843.
CONCLUSIONS: SLD associated with malnutrition following pancreatectomy can be predicted using plasma apoA2-i monitoring.