血清Mac-2结合蛋白聚糖异构体对2型糖尿病患者肝纤维化的诊断价值  

Value of serum Mac-2 binding proteoglycan isomer in diagnosing liver fibrosis in patients with type 2 diabetes mellitus

作　　者：李军[1] 陈弘东 谭方[1] 潘慧钗 徐筱青 朱庆文 LI Jun;CHEN Hongdong;TAN Fang;PAN Huichai;XU Xiaoqing;ZHU Qingwen(Department of Endocrinology,Beijing Hepingli Hospital,Beijing,100000)

机构地区：[1]北京市和平里医院内分泌科,北京100000

出　　处：《实用临床医药杂志》2022年第7期109-113,119,共6页Journal of Clinical Medicine in Practice

基　　金：教育部长江学者和创新团队发展计划(IRT0810)。

摘　　要：目的 探讨血清Mac-2结合蛋白聚糖异构体(M2BPGi)对2型糖尿病(T2DM)患者肝纤维化的诊断价值。方法 招募272例T2DM患者作为研究对象,将其中122例合并非酒精性脂肪肝病(NAFLD)的患者纳入T2DM合并NAFLD组,将150例无NAFLD的T2DM患者纳入T2DM组,另收集同期接受健康体格检查的150名健康志愿者(正常对照组)的血清样本作为对照。根据NAFLD纤维化评分的不同,将T2DM合并NAFLD组患者分为无肝纤维化亚组44例、不确定亚组42例和肝纤维化亚组36例。采用化学发光酶免疫分析法检测各组M2BPGi水平,并比较各组实验室检查指标水平。采用Spearman秩相关分析法分析各指标的相关性,采用受试者工作特征(ROC)曲线分析血清M2BPGi对T2DM患者合并NAFLD、T2DM合并NAFLD患者肝纤维化的诊断价值。结果 T2DM合并NAFLD组的血清M2BPGi水平高于T2DM组、正常对照组,差异有统计学意义(P<0.001)。血清M2BPGi诊断T2DM患者合并NAFLD的曲线下面积(AUC)为0.919(95%CI为0.885~0.954)。肝纤维化亚组4项肝纤维化指标[透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(Ⅳ-C)]和血清M2BPGi水平均高于无肝纤维化亚组、不确定亚组,且不确定亚组水平高于无肝纤维化亚组,差异有统计学意义(P<0.05)。ROC曲线显示,血清M2BPGi诊断T2DM合并NAFLD患者肝纤维化的AUC为0.993(95%CI为0.983~1.000),大于HA、LN、PCⅢ、Ⅳ-C单独诊断时的AUC(P<0.05)。T2DM合并NAFLD患者的血清M2BPGi水平与HA、LN、PCⅢ、Ⅳ-C水平均呈显著正相关(r=0.741、0.835、0.851、0.867,P<0.05)。结论 T2DM合并NAFLD患者血清M2BPGi水平普遍升高,且M2BPGi水平与肝纤维化进展有关。M2BPGi有望成为评估T2DM合并NAFLD患者肝纤维化进展的新型标志物。Objective To explore value of serum Mac-2 binding proteoglycan isomer(M2 BPGi) in diagnosing liver fibrosis in patients with type 2 diabetes mellitus(T2 DM). Methods A total of 272 patients diagnosed as T2 DM were recruited as study objects, and were divided into T2 DM combined with NAFLD group with 122 patients[non-alcoholic fatty liver disease(NAFLD)]and T2 DM group[150 T2 DM patients without NAFLD]. In addition, serum samples from 150 healthy volunteers(normal control group) who underwent physical examinations in our hospital at the same time were collected as normal controls. According to different NAFLD fibrosis scores, T2 DM patients combined with NAFLD were divided into liver fibrosis free subgroup(n=44), uncertain subgroup(n=42), and liver fibrosis subgroup(n=36). Chemiluminescence enzyme immunoassay was used to analyze the level of serum M2 BPGi. The levels of laboratory examination indexes in each group were compared. Spearman rank correlation test was used to analyze the correlations of all indicators, and receiver operating characteristic( ROC) curve was used to analyze the diagnostic value of serum M2BPGi for NAFLD in T2DM patients and for liver fibrosis of T2DM patients with NAFLD. Results The serum M2BPGi in the T2DM combined with NAFLD group was significantly higher than that in the T2DM group and normal control group( P < 0. 001). The area under the curve( AUC) of serum M2BPGi in diagnosis of T2DM combined with NAFLD was 0. 919( 95% CI,0. 885 to 0. 954). Four indicators of liver fibrosis[hyaluronic acid( HA),laminin( LN),procollagen type Ⅲ( PC-Ⅲ) and collagen type Ⅳ( Ⅳ-C) ]and serum M2BPGi levels in the liver fibrosis subgroup were higher than those in the liver fibrosis free subgroup and the uncertain subgroup,and the above indicators of the uncertain subgroup were higher than those of the liver fibrosis free subgroup,the differences were statistically significant( P < 0. 05). ROC curve analysis showed that AUC of serum M2BPGi in diagnosis of liver fibrosis in T2DM patients with NAFLD wa

关 键 词：Mac-2结合蛋白聚糖异构体 2型糖尿病 非酒精性脂肪肝 肝纤维化 诊断效能 

分 类 号：R587.1[医药卫生—内分泌] R392.6[医药卫生—内科学]