Unexplained CK elevations in patients with nonalcoholic steatohepatitis

摘要

To the EditorNonalcoholic steatohepatitis (NASH) is a clin-icopathological condition characterized by stea-tosis, lobular inflammation and sometimes fibrosis of the liver. NASH is strongly associated with insulin resistance and the metabolic syndrome (1). Insulin resistance and the metabolic syndrome are also associated with pathophysio-logic changes in skeletal muscle such as excess triglyceride accumulation (2) and the lipid content within muscle fibers has been strongly correlated with the severity of insulin resistance (3). Potential shared mechanisms for these changes in the liver and muscle include defects in mitochon-drial fatty acid metabolism (4-7). Elevated serum creatine kinase (CK) is a marker for myocyte injury. We have observed elevated CK values in some patients with NASH and question whether this could be related to pathological changes in the skeletal muscle related to insulin resistance. The purpose of this letter is to describe this observation in the patients that we have identified.