血清铁蛋白可识别肠衰竭相关性肝病  

Diagnostic value of serum ferritin in intestinal failure-associated liver disease

作　　者：孙广明 夏宇飞 黄龙昌 古丽苏杜姆·麦提阿卜拉 章黎 高学金 王新颖 SUN Guang-ming;XIA Yu-fei;HUANG Long-chang;Maitiabula Gulisudumu;ZHANG Li;GAO Xue-jin;WANG Xin-ying(Department of General Surgery,Nanjing Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210002,Jiangsu,China;School of Medicine,Southeast University,Nanjing 210009,Jiangsu,China)

机构地区：[1]南京大学医学院附属金陵医院/东部战区总医院普通外科,江苏南京210002 [2]东南大学医学院,江苏南京210009

出　　处：《肠外与肠内营养》2024年第3期147-153,共7页Parenteral & Enteral Nutrition

基　　金：国家自然科学基金面上项目(81770531,82370900)。

摘　　要：目的:探讨血清铁蛋白在肠衰竭相关性肝病中的诊断价值。方法:回顾性分析2019年1月至2022年12月在南京大学附属金陵医院普通外科收治的成人短肠综合征病人的临床资料,通过线性回归确定血清铁蛋白和肝脏酶谱的相关性,通过多因素Logistic回归分析筛选肝损伤的潜在危险因素,并建立肝纤维化预测模型。同时计算曲线下面积以评估模型的准确性。结果:共纳入106例短肠综合征病人,其中血清铁蛋白(SF)升高的有55例(51.9%)。线性回归分析显示血清铁蛋白和ALT(r=0.427,P<0.001)、ALP(r=0.365,P<0.001)以及γ-GT(r=0.423,P<0.001)呈正相关,单因素Logistic回归分析显示血清铁蛋白水平越高,差异越明显[SF>ULN(血清铁蛋白正常值上限),P=0.033;SF>1.5×ULN,P=0.018;SF>2.5×ULN,P=0.006]。多因素Logistic回归分析显示:PN依赖(OR=3.366,P=0.017)、血清铁蛋白>2.5 ULN(OR=3.292,P=0.014)是肠衰竭相关性肝病—肝纤维化的独立危险因素,受试者工作曲线(ROC)显示曲线下面积为74.8%,95%CI:0.652~0.844。结论:血清铁蛋白可作为一个可靠的临床生物标志物,帮助识别肠衰竭相关性肝病。Objective:To investigate the diagnostic value of serum ferritin in intestinal failure-associated liver disease.Methods:Clinical data of adult patients with short bowel syndrome admitted to the Department of General Surgery of Jinling Hospital affiliated to Nanjing University from January 2019 to December 2022 were retrospectively analyzed to determine the correlation between serum ferritin and liver enzyme profiles by linear regression,to screen the potential risk factors of liver injury by multifactorial Logistic regression analysis,and to establish a prediction model for liver fibrosis.The area under the curve was also calculated to assess the accuracy of the model.Results:A total of 106 patients with short bowel syndrome were included,of whom 55(51.9%)had elevated serum ferritin(SF).Linear regression analysis showed a positive correlation between serum ferritin and ALT(r=0.427,P<0.001),ALP(r=0.365,P<0.001),andγ-GT(r=0.423,P<0.001),and one-way Logistic regression analysis showed that the higher the level of serum ferritin,the more pronounced the difference was(SF>ULN)The one-way logistic regression analysis showed that the higher the serum ferritin level,the more significant the difference was[SF>ULN(upper limit of normal value of serum ferritin),P=0.033;SF>1.5×ULN,P=0.018;SF>2.5×ULN,P=0.006].Multifactorial logistic regression analysis showed that PN dependence(OR=3.366,P=0.017)and serum ferritin>2.5 ULN(OR=3.292,P=0.014)were independent risk factors for intestinal failure-associated liver disease-liver fibrosis,and the receiver operating curve(ROC)of the subjects showed area under the curve of 74.8%,95%CI:0.652~0.844.Conclusion:Serum ferritin can be used as a reliable clinical biomarker to help identify intestinal failure-associated liver disease.

关 键 词：血清铁蛋白 肠外营养 肠衰竭 肝纤维化 

分 类 号：R656[医药卫生—外科学]