血清胰脂肪酶在非酒精性脂肪性肝病中的临床意义  

Clinical significance of serum pancreatic lipase in nonalcoholic fatty liver disease

作　　者：熊永瑞[1] 毛小红[1] 张娟文[2] 赵莹[2] 吴建平[2] 

机构地区：[1]平湖市中医院检验科,浙江平湖314200 [2]浙江大学附属第一医院检验科,浙江杭州310003

出　　处：《检验医学》2016年第3期180-184,共5页Laboratory Medicine

摘　　要：目的研究血清胰脂肪酶（P-LIP）与非酒精性脂肪性肝病（NAFLD）的关系及预测肝纤维化的应用价值。方法测定700例经腹部超声确诊的NAFLD患者和310名健康体检者（正常对照组）人体学参数及血液学指标,包括身高、体重指数、收缩压、舒张压、P-LIP、淀粉酶（AMY）、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、γ-谷氨酰基转移酶（GGT）、磷酸肌酸激酶（CK）、甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、空腹血糖（FPG）、尿酸（UA）、血清铁（Fe）、唾液酸（SA）、高敏C反应蛋白（hs-CRP）和白细胞（WBC）。根据2004年中华医学会糖尿病学分会关于代谢综合征（MS）的建议指南将NAFLD患者分为合并MS组和未合并MS组。采用Spearman相关性分析评价P-LIP活性与其他变量之间的相关性;采用逐步回归分析法评估不同P-LIP水平NAFLD患者的肝纤维化晚期[肝纤维化4项指数（FIB-4）评分≥1.3]风险。结果与正常对照组比较,NAFLD组HDL-C和AMY明显降低,而其他指标均明显升高（P〈0.05）。NAFLD合并MS组P-LIP活性[26（4-208）U/L]明显低于NAFLD未合并MS组[30（14-298）U/L]和正常对照组[36（5-201）U/L]（P均〈0.05）。P-LIP与HDL-C及AMY呈正相关（r值分别为0.154、0.211,P〈0.05）,与ALT、GGT、TG、FPG、UA、SA、hs-CRP和WBC呈负相关（r值分别为-0.171、-0.167、-0.223、-0.155、-0.201、-0.154、-0.162,P均〈0.05）。逐步回归分析法显示血清P-LIP水平是预测肝纤维化晚期的独立因素[比值比（OR）=2.356,95%可信区间（CI）：1.235-5.331]。结论血清P-LIP与NAFLD密切相关,是预测NAFLD患者肝纤维化进展后期发生的独立因素。Objective To investigate the correlation of serum pancreatic lipase（P-LIP） with nonalcoholic fatty liver disease（NAFLD） and the clinical significance for predicting hepatic fibrosis. Methods A total of 700 NAFLD patients diagnosed by abdominal ultrasonography and 310 healthy subjects（healthy control group）were enrolled,and their body parameters and hematological indices were determined,like height,body mass index,systolic blood pressure,diastolic blood pressure,P-LIP,amylase（AMY）,alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,gamma-glutamyltransferase（GGT）,creatine kinase（CK）,triglyceride（TG）,total cholesterol（TC）,high-density lipoprotein cholesterol（HDL-C）,fasting plasma glucose（FPG）, uric acid（UA）,serum iron（Fe）,sialic acid（SA）,high-sensitivity C-reactive protein（hs-CRP） and white blood cell（WBC）. According to the guidelines for the diagnosis of metabolic syndrome（MS） issued by Chinese Diabetes Society of Chinese Medical Association in 2004,the NAFLD patients were classified into 2 groups,MS group and non-MS group. Spearman correlation analysis was used to evaluate the correlation of P-LIP levels with other parameters. Stepwise regression analysis was used to evaluate different P-LIP levels＇ risk for advanced hepatic fibrosis [fibrosis index based on 4 factors（FIB-4）≥ 1.3] in NAFLD patients. Results Compared with healthy control group,NAFLD group had significantly low levels of HDL-C and AMY,and the other parameters increased significantly（P〈0.05）. The P-LIP levels in MS group [26（4-208）U/L] were significantly lower than those in non-MS group [30（14-298）U/L] and healthy control group [36（5-201）U/L]（P〈0.05）. P-LIP was positively correlated with HDL-C and AMY（r = 0.154 and 0.211,P〈0.05）,and it was negatively correlated with ALT,GGT,TG,FPG,UA,SA,hs-CRP and WBC（r =-0.171,-0.167,-0.223,-0.155,-0.201,-0.154 and-0.162,P〈0.05）. Stepwise regression analysis showed that serum P-LIP was an ind

关 键 词：胰脂肪酶 非酒精性脂肪性肝病 代谢综合征 

分 类 号：R446.1[医药卫生—诊断学]