非酒精性脂肪性肝病合并2型糖尿病患者血清瘦素、视黄醇结合蛋白4和胆碱酯酶水平变化及其临床意义研究  

Changes of serum leptin,retinol-binding protein-4 and cholinesterase levels in patients with NAFLD and T2DM

作　　者：尹会芬 于红艳[2] 刘志平[1] Yin Huifen;Yu Hongyan;Liu Zhiping(Department of Gastroenterology,Hankou Hospital,Wuhan 430000,Hubei Province,China)

机构地区：[1]武汉市汉口医院消化内科,430000 [2]哈尔滨医科大学附属第一医院微创胆道外科

出　　处：《实用肝脏病杂志》2023年第4期500-503,共4页Journal of Practical Hepatology

基　　金：武汉市科技局医学科研项目(编号:WX20A08)。

摘　　要：目的探讨非酒精性脂肪性肝病(NAFLD)合并2型糖尿病(T2DM)患者血清瘦素、视黄醇结合蛋白-4(RBP-4)和胆碱酯酶(ChE)水平变化及其临床意义。方法2019年4月~2022年4月我院诊治的NAFLD合并T2DM者74例(其中脂肪变轻度28例,中度25例,重度21例)、NAFLD患者30例、T2DM患者30例和健康人30例,采用ELISA法检测血清瘦素和RBP4,常规检测血清ChE水平,应用受试者工作特征曲线下面积(AUC)评估各指标预测重度肝脂肪变的效能。结果NAFLD合并T2DM患者胰岛素抵抗指数为(5.8±1.7),显著高于T2DM患者的(3.9±1.1)、NAFLD患者的(3.6±0.9)或健康人的[(1.9±0.4),P<0.05],而胰岛素敏感性指数为(-4.4±0.5),显著低于T2DM患者的(-4.0±0.4)、NAFLD患者的(-4.0±0.3)或健康人的[(-3.5±0.3),P<0.05];NAFLD合并T2DM患者血清瘦素和RBP4水平分别为(17.1±3.1)μg/L和(30.6±2.8)mg/L,显著高于T2DM患者[分别为(12.3±2.7)μg/L和(24.1±2.3)mg/L,P<0.05]或NAFLD患者[分别为(13.1±2.4)μg/L和(23.9±2.7)mg/L,P<0.05]或健康人[分别为(9.7±1.9)μg/L和(20.1±1.9)mg/L,P<0.05],而血清ChE水平为(8337.3±755.9)IU/L,显著低于T2DM患者[(9080.2±684.7)IU/L,P<0.05]或NAFLD患者[(9159.9±812.2)IU/L,P<0.05]或健康人[(9987.4±975.4)IU/L,P<0.05];重度脂肪变患者血清瘦素和RBP4水平显著高于中度或轻度患者,而血清ChE水平显著低于中度或轻度患者(P<0.05);应用血清瘦素、RBP4和ChE水平联合检测预测重度NAFLD的AUC为0.834,其灵敏度、特异度和准确度分别为76.2%、81.1%和79.7%,显著高于三项指标单独评估(其AUCs分别为0.727、0.739和0.708,P<0.05)。结论NAFLD合并T2DM患者血清瘦素和RBP4水平升高,而血清ChE水平降低,它们血清水平的变化可在一定程度上反映NAFLD的严重程度,联合检测可以帮助评估病情。Objective This study was aimed at exploring the implication of serum leptin,retinol binding protein-4(RBP4)and cholinesterase(ChE)levels in patients with non-alcoholic fatty liver diseases(NAFLD)and type 2 diabetes mellitus(T2DM).Methods 74 patients with NAFLD and T2DM,including mild fatty liver in 28 cases,moderate in 25 cases and severe in 21 cases,30 patients with NAFLD,30 patients with T2DM and 30 healthy individuals were recruited in our hospital between April 2019 and April 2022.Serum leptin and RBP4 levels were detected by ELISA,and serum ChE level was detected routinely.The diagnostic performance was evaluated by the area under the receiver operating characteristic(AUC)curves.Results The HOMA-IR in patients with NAFLD and T2DM was(5.8±1.7),much higher than(3.9±1.1)in patients with T2DM,or(3.6±0.9)in patients with NAFLD or[(1.9±0.4),P<0.05]in healthy persons,while the insulin sensitivity index was(-4.4±0.5),much lower than(-4.0±0.4)in patients with T2DM or(-4.0±0.3)in patients with NAFLD or healthy persons[(-3.5±0.3),P<0.05];serum leptin and RBP4 levels in patients with NAFLD and T2DM were(17.1±3.1)μg/L and(30.6±2.8)mg/L,significantly higher than[(12.3±2.7)μg/L and(24.1±2.3)mg/L,P<0.05]in patients with T2DM or[(13.1±2.4)μg/L and(23.9±2.7)mg/L,P<0.05]in patients with NAFLD or[(9.7±1.9)μg/L and(20.1±1.9)mg/L,P<0.05]in healthy persons,while serum ChE level was(8337.3±755.9)IU/L,much lower than[(9080.2±684.7)IU/L,P<0.05]in patients with T2DM or[(9159.9±812.2)IU/L,P<0.05]in patients with NAFLD or[(9987.4±975.4)IU/L,P<0.05]in healthy persons;serum leptin and RBP4 levels in NAFLD/T2DM patients with severe hepatic steatosis was much higher than,while serum ChE level was much lower than in those with moderate or mild hepatic steatosis(P<0.05);the AUC was 0.834,with the sensitivity,specificity and accuracy of 76.2%,81.1%and 79.7%when serum leptin,RBP4 and ChE level combination was applied to predict severe hepatic steatosis in patients with NAFLD and T2DM,much superior to the three parameters

关 键 词：非酒精性脂肪性肝病 2型糖尿病 胰岛素抵抗 瘦素 视黄醇结合蛋白-4 胆碱酯酶 

分 类 号：R575.5[医药卫生—消化系统] R587.1[医药卫生—内科学]