血清LPO、APN和TGF-β1水平检测对酒精性肝硬化患者病情严重程度和预后评估的价值  

The value of serum LPO, APN and TGF-β1 levels in evaluating the severity and prognosis of patients with alcoholic cirrhosis

作　　者：石红 薛小春 王德琴 吕忠美 SHI Hong;XUE Xiao-chun;WANG De-qin;LV Zhong-mei(Department of Gastroenterology,Hai’an Hospital Affiliated to Nantong University,Jiangsu 226600,China)

机构地区：[1]南通大学附属海安医院消化内科,江苏226600

出　　处：《肝脏》2023年第1期70-74,共5页Chinese Hepatology

基　　金：江苏省卫生健康委科研课题(H2018053)。

摘　　要：目的 探讨过氧化脂质(LPO)、脂联素(APN)和转化生长因子-β1(TGF-β1)水平联合检测对酒精性肝硬化(ALC)病情严重程度和预后评估的价值。方法 选择2019年1月—2021年6月南通大学附属海安医院收治的152例酒精性肝病(ALD)患者,按疾病类型分为酒精性脂肪肝(AFL)组、酒精性肝炎(AH)组和ALC组;将ALC组按照改良Child-Pugh分级标准分为A级、B级和C级亚组,按照终末期肝病模型(MELD)评分标准分为轻度、中度和重度亚组。比较AFL、AH和ALC三组的血清LPO、APN和TGF-β1水平,比较ALC组中改良Child-Pugh分级标准A级、B级和C级亚组以及MELD评分轻度、中度和重度亚组的血清LPO、APN和TGF-β1水平,Pearson分析ALC组LPO、APN和TGF-β1水平与总胆红素(TBil)、白蛋白(Alb)和肝脏硬度值(LSM)水平的相关性,绘制ROC曲线,分析LPO、APN和TGF-β1水平对ALC的诊断效能。结果 ALC组的LPO和TGF-β1水平分别为(7.56±1.68)μmol/L和(287.63±59.52)μg/L,高于AH组和AFL组的(4.92±1.03)μmol/L、(3.46±0.85)μmol/L和(215.19±43.87)μg/L、(168.53±32.48)μg/L;APN水平为(4.29±1.03) mg/L,低于AH组和AFL组的(7.46±1.82) mg/L和(12.57±3.46) mg/L(F=16.736、13.275、19.418,P<0.05)。ALC组中,Child-Pugh C级亚组的LPO和TGF-β1水平为(9.04±1.85)μmol/L和(341.67±70.25)μg/L,高于B级和A级亚组的(7.38±1.52)μmol/L、(6.13±1.27)μmol/L和(279.83±57.46)μg/L、(234.51±48.38)μg/L;APN水平为(3.37±0.85) mg/L,低于B级和A级亚组的(4.42±1.16) mg/L和(5.76±1.34) mg/L(F=13.259、11.762、15.386,P<0.05)。重度亚组的LPO和TGF-β1水平为(9.83±1.96)μmol/L和(364.78±76.91)μg/L,高于中度和轻度亚组的(7.54±1.61)μmol/L、(5.83±1.14)μmol/L和(290.62±59.73)μg/L、(225.76±45.82)μg/L;APN水平为(3.08±0.74) mg/L,低于中度和轻度亚组的(4.26±1.09) mg/L和(5.93±1.42) mg/L(F=15.461、13.628、17.853,P<0.05)。Pearson分析显示,ALC的LPO和TGF-β1水平与TBil和LSM水平呈正相关,与Alb水平呈负相关;APN水平与AlbObjective To investigate the value of a combined determination with lipid peroxide(LPO), adiponectin(APN) and transforming growth factor-β1(TGF-β1) for the severity and prognosis of alcoholic cirrhosis(ALC). Methods One hundred and fifty-two patients with alcoholic liver disease(ALD) were divided into alcoholic fatty liver(AFL) group, alcoholic hepatitis(AH) group and ALC group according to the types of their diseases. The ALC group was further divided into A, B and C subgroups according to the modified Child-Pugh grading standard, and mild, moderate and severe subgroups according to the model of end-stage liver disease(MELD) scoring standard. The levels of serum LPO, APN and TGF-β1 in patients of AFL, AH and ALC groups, and in different subgroups of patients in the ALC group were compared. The correlation between the levels of LPO, APN and TGF-β1 and total bilirubin(TBil), Albumin(Alb) and liver hardness(LSM) in ALC group were analyzed by Pearson method. Receiver operating characteristic(ROC) curves were drawn and the diagnostic efficacies of LPO, APN and TGF-β1 for the severity and prognosis of ALC patients were analyzed. Results The levels of LPO and TGF-β1 in ALC group were 7.56±1.68 μmol/L and 287.63±59.52 μg/L, respectively, which were higher than those of AH group(4.92±1.03 μmol/L and 3.46±0.85 μmol/L) and AFL group(215.19±43.87 μg/L and 168.53±32.48 μg/L);APN level was 4.29±1.03 mg/L, which was lower than those of 7.46±1.82 mg/L in AH group and 12.57±3.46 mg/L in AFL group(F=16.736, 13.275, 19.418, P<0.05). The levels of LPO and TGF-β1 in child-Pugh grade C subgroup of ALC group were 9.04±1.85μmol/L and 341.67±70.25μg/L. respectively, which were higher than those of 7.38±1.52μmol/L, 6.13±1.27 μmol/L in grade B, and 279.83±57.46 μg/L, 234.51±48.38 μg/L in grade A subgroups. The APN level in child-Pugh grade C subgroup was 3.37±0.85 mg/L, which was lower than those of 4.42±1.16 mg/L in grade B and 5.76±1.34 mg/L in grade A subgroups(F=13.259, 11.762, 15.386, P<0.05). The

关 键 词：酒精性肝硬化 过氧化脂质 脂联素 转化生长因子-β1 病情程度 预后 

分 类 号：R575.5[医药卫生—消化系统]