血清自分泌运动因子诊断非酒精性脂肪肝合并肝纤维化的价值研究  

Value of serum autotaxin in the diagnosis of non-alcoholic fatty liver with liver fibrosis

作　　者：余卫中[1] 张刚[1] 甘洪颖 Yu Weizhong;Zhang Gang;Gan Hongying(Department of Gastroenterology,Affiliated Hospital of Jianghan University,Wuhan 430015,China)

机构地区：[1]江汉大学附属医院消化内科,武汉430015 [2]武汉市中心医院消化内科

出　　处：《临床内科杂志》2020年第11期789-791,共3页Journal of Clinical Internal Medicine

基　　金：湖北省卫生健康委员会指导性项目(WJ2019F021)。

摘　　要：目的探讨血清自分泌运动因子(ATX)诊断非酒精性脂肪性肝病(NAFLD)合并肝纤维化的临床价值。方法根据肝纤维化程度将47例NAFLD合并肝纤维化患者分为NAFLD轻度肝纤维化组(6例)和NAFLD重度肝纤维化组(21例),并纳入25例无肝纤维化NAFLD患者作为NAFLD组。采用酶联免疫吸附试验检测血清ATX水平,采用放射免疫法检测血清透明质酸(HA)水平,同时计算AST和血小板比率指数(APRI)和肝纤维化指数(FIB-4)。比较各组患者血清ATX、HA水平及APRI、FIB-4。采用Spearman法分析血清ATX与血清HA、APRI、FIB-4的相关性。采用受试者工作特征(ROC)曲线分析血清ATX、HA及APRI、FIB-4单一及联合诊断NAFLD合并肝纤维化的临床价值。结果3组患者的血清ATX、HA表达水平及APRI、FIB-4比较差异均有统计学意义(P<0.05),NAFLD轻度肝纤维化组及NAFLD重度肝纤维化组血清ATX、HA表达水平及APRI、FIB-4均明显高于NAFLD组,且NAFLD重度肝纤维化组上述指标明显高于NAFLD轻度肝纤维化组(P<0.05)。NAFLD患者的血清ATX与血清HA、APRI、FIB-4均呈正相关(P<0.05);血清ATX联合血清HA、APRI、FIB-4诊断NAFLD合并肝纤维化的ROC曲线下面积(0.872)、敏感度(85.1%)及特异度(76.0%)优于单一指标检测。结论血清ATX可作为诊断NAFLD合并肝纤维化的指标之一,联合其他指标可明显提高其诊断敏感度及特异度。Objective To investigate the clinical value of serum autotaxin(ATX)in the diagnosis of non-alcoholic fatty liver(NAFLD)with liver fibrosis.Methods Forty-seven NAFLD patients with liver fibrosis were divided into the NAFLD group with mild liver fibrosis(26 cases)and the NAFLD group with severe liver fibrosis(21 cases)according to the severity of liver fibrosis,and 25 NAFLD patients without liver fibrosis were included as the NAFLD group.The serum ATX levels were detected by enzyme-linked immunosorbent assay,and the serum hyaluronic acid(HA)levels were detected by radioimmunoassay.Meanwhile,the AST-to-platelet ratio index(APRI)and fibrosis-4(FIB-4)were calculated.The levels of serum ATX and HA,APRI and FIB-4 in each group were compared.The correlation between serum ATX and serum HA,APRI and FIB-4 was analyzed by Spearman method.The clinical value of serum ATX,HA and APRI,FIB-4 isolated and combined diagnosis of NAFLD with liver fibrosis was analyzed by the receiver operator characteristic(ROC)curve.Results There were significant differences of the serum ATX,HA and APRI,FIB-4 among three groups(P<0.05).The serum ATX,HA and APRI,FIB-4 in the NAFLD mild liver fibrosis group and the NAFLD severe liver fibrosis group were significantly higher than those in the NAFLD group,while above indexes in the NAFLD severe liver fibrosis group were significantly higher than those in the NAFLD mild liver fibrosis group(P<0.05).There was a positive correlation between the serum ATX and HA,APRI,FIB-4 of NAFLD patients(P<0.05).Area under ROC curve(0.872),sensitivity(85.1%)and specificity(76.0%)of the serum ATX combined with serum HA,APRI,FIB-4 in the diagnosis of NAFLD with hepatic fibrosis were better than those of single index.Conclusion Serum ATX can be used as a index for the diagnosis of NAFLD with liver fibrosis,and the combination of serum ATX and other indexes can significantly improve the sensitivity and specificity of diagnosis.

关 键 词：自分泌运动因子 非酒精性脂肪性肝病 肝纤维化 

分 类 号：R575.5[医药卫生—消化系统] R575.2[医药卫生—内科学]