非酒精性脂肪性肝病患者血清胱抑素C、脂蛋白α和nesfatin-1水平变化及其临床意义探讨  

Clinical implication of serum cystatin C,lipoproteinαand nesfatin-1 levels in patients with non-alcoholic fatty liver diseases

作　　者：樊叶[1] 张喜梅 张岩[1] Fan Ye;Zhang Ximei;Zhang Yan(Department of Gastroenterology,Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing 210006,Jiangsu Province,China)

机构地区：[1]南京医科大学附属南京市第一医院消化内科,南京市210006

出　　处：《实用肝脏病杂志》2022年第6期816-819,共4页Journal of Practical Hepatology

基　　金：国家自然科学基金资助项目(编号:81700458)。

摘　　要：目的探讨非酒精性脂肪性肝病(NAFLD)患者血清胱抑素C(CysC)、脂蛋白α(Lp-α)和人新饱食分子蛋白1(nesfatin-1)水平变化及其临床意义。方法2019年7月~2021年11月我院诊治的NAFLD患者119例和同期经年龄和性别匹配的健康体检者65例,采用ELISA法检测血清CysC、Lp-α和nesfatin-1水平,应用受试者工作特征曲线下面积(AUC)评估血清指标评估重度NAFLD的效能。结果NAFLD患者血清CysC水平为(1.5±0.4)mg/L,显著高于对照组【(0.8±0.2)mg/L,P<0.05】,而血清Lp-α和nesfatin-1水平分别为(88.5±18.6)mg/L和(0.9±0.2)ng/mL,显著低于对照组【分别为(140.3±29.5)mg/L和(1.6±0.3)ng/mL,P<0.05】;重度NAFLD患者血清CysC水平为(1.9±0.3)mg/L,显著高于中度患者【(1.6±0.3)mg/L,P<0.05】或轻度患者【(1.2±0.2)mg/L,P<0.05】,而血清Lp-α和nesfatin-1水平分别为(63.6±15.9)mg/L和(0.4±0.1)ng/mL,显著低于中度患者【分别为(88.2±14.3)mg/L和(0.9±0.2)ng/mL,P<0.05】或轻度患者【分别为(104.3±17.8)mg/L和(1.2±0.3)ng/mL,P<0.05】;Logistic回归分析显示血清CysC、空腹血糖、甘油三酯、低密度脂蛋白胆固醇高水平或血清Lp-α和nesfatin-1低水平是严重NAFLD发生的独立危险因素(P<0.05);联合应用血清CysC、Lp-α和nesfatin-1水平评估重度NAFLD发生的AUC为0.887,显著高于三项指标单独评估的0.738、0.773和0.776(P<0.05),其灵敏度、特异度和准确度分别为86.7%、80.9%和82.4%。结论NAFLD患者血清CysC水平升高,而血清Lp-α和nesfatin-1水平降低,它们水平的变化与肝脂肪变程度相关,其临床意义值得探讨。Objective The aim of this study was to explore the changes of serum cystatin C(CysC),lipoproteinα(Lp-α)and human new satiety molecule protein 1(nesfatin-1)levels in patients with non-alcoholic fatty liver diseases(NAFLD).Methods A total of 119 patients with NAFLD and 65 healthy individuals with matched age and gender were enrolled in our hospital between July 2019 and November 2021.Serum CysC,Lp-αand nesfatin-1 levels were detected by enzyme-linked immunosorbent assay.The area under the receiver operating characteristic curve(AUROC)was applied to evaluate the diagnostic efficacy of serum parameters.Results Serum CysC level in patients with NAFLD was(1.5±0.4)mg/L,much higher than[(0.8±0.2)mg/L,P<0.05],while serum Lp-αand nesfatin-1 levels were(88.5±18.6)mg/L and(0.9±0.2)ng/mL,much lower than[(140.3±29.5)mg/L and(1.6±0.3)ng/mL,respectively,P<0.05]in the healthy persons;serum CysC level in patients with severe fatty liver was(1.9±0.3)mg/L,much higher than[(1.6±0.3)mg/L,P<0.05]in patients with moderate fatty liver or[(1.2±0.2)mg/L,P<0.05]in patients with mild fatty liver,while serum Lp-αand nesfatin-1 levels were(63.6±15.9)mg/L and(0.4±0.1)ng/mL,significantly lower than[(88.2±14.3)mg/L and(0.9±0.2)ng/mL,P<0.05]in patients with moderate fatty liver or[(104.3±17.8)mg/L and(1.2±0.3)ng/mL,P<0.05]in patients with mild fatty liver;the Logistic regression analysis showed that increased serum CysC,fasting plasma glucose,TC and LDL-C levels or decreased serum Lp-αand nesfatin-1 levels were all the independent risk factors for severe fatty liver(P<0.05);the AUROC was 0.887,with the sensitivity of 86.7%,the specificity of 80.9%and the accuracy of 82.4%,when the combination of the three serum parameters was applied in predicting severe fatty liver,much superior to 0.738,0.773 and 0.776(P<0.05)by any serum parameter alone.Conclusion Serum CysC level increases,while serum Lp-αand nesfatin-1 levels decrease in patients with NAFLD,which warrants further investigation for clinical application.

关 键 词：非酒精性脂肪性肝病 胱抑素C 脂蛋白Α 人新饱食分子蛋白1 

分 类 号：R575.5[医药卫生—消化系统]