血清细胞角蛋白18诊断非酒精性脂肪性肝病的价值探讨  

Serum cytokeratin 18 levels in the diagnosis of patients with nonalcoholic fatty liver diseases

作　　者：钱建成[1] 陆璐[1] 娄国强[2] 荀运浩[3] 施军平[3] 

机构地区：[1]浙江中医药大学 [2]杭州师范大学附属医院 [3]杭州市第六人民医院

出　　处：《实用肝脏病杂志》2012年第4期291-294,共4页Journal of Practical Hepatology

基　　金：杭州市科技计划项目(20110833B07);杭州市医药卫生科技计划重点项目(2011Z006)

摘　　要：目的研究血清细胞角蛋白18(CK18)水平诊断非酒精性脂肪性肝病的价值。方法选择93例非酒精性脂肪性肝病(NAFLD)患者和44名年龄与性别相匹配的健康人,检测血清CK18水平,同时测定ALT、AST、GGT、FBG、FINS、TC、TG、HDL、LDL水平,以及血压、身高、体重、腰围(WC)、臀围(HC),并计算腰臀比(WHR)和体重指数(BMI);应用稳态模型评估法计算胰岛素抵抗指数(HOMA-IR)。对其中30例NAFLD患者进行肝组织病理学检查。结果 NAFLD患者血清CK18水平显著高于正常对照组(P<0.001);血清ALT升高的NAFLD患者血清CK18水平(16.38±8.1ng/ml)高于ALT正常组(5.655±4.72 ng/ml),差异有统计学意义(P<0.001);经病理学检查证实的非酒精性脂肪性肝炎患者血清CK18水平(20.93±8.07ng/ml)明显高于非酒精性单纯性脂肪肝患者(7.61±5.51ng/ml),差异有统计学意义(P<0.001);NAFLD患者血清CK18水平与肝脂肪变(r=0.527,P=0.003)、炎症(r=0.662,P<0.001)和纤维化(r=0.715,P<0.001)具有显著的相关性。结论血清CK18水平能反映NAFLD患者肝脏炎症和纤维化程度,因而具有一定的诊断意义。Objective To investigate serum cytokeratin （CK18） levels in the diagnosis of patients with nonalcoholic fatty liver diseases （NAFLD）. Methods Ninety-three patients with NAFLD and forty-four healthy persons matched with age and gender were included in this study. Serum ALT,AST,GGT,CK18,FBG,FINS,TC, TG,HDL,LDL,DBP,SBP,height,weight,WC,HC,and waist hip ratio,body mass index and homoeostasis model assessment of insulin resistance were calculated. There were thirty patients with NAFLD undergoing liver bioposy. Results There was an significantly high serum CK18 levels in patients with NAFLD as compared with control subjects （P〈O.O01）;serum CK18 level in patients with elevated ALT group （16.38±8.1ng/ml） was higher than in normal ALT group （5.655±4.72ng/ml,P〈O.OO1）;serum CK18 level （20.93±8.07ng/ml） in NASH group was higher than in NAFL group （7.61±5.51ng/ml,P〈0.001）;Scrum CKI8 level was positively correlated to the degree of steatosis （r=0.527,P=0.003）,lobular inflammation （r=0.662,P〈0.001）,and fibrosis （r=0.715,P〈0.001）. Conclusion Serum CK18 level reflects the degree of lobular inflammation and fibrosis in NAFLD and has certain diagnostic value for NAFLD.

关 键 词：非酒精性脂肪性肝病 细胞角蛋白18 肝组织病理学 诊断 

分 类 号：R575.5[医药卫生—消化系统]