血清瘦素及可溶性瘦素受体在诊断非酒精性脂肪肝合并肝纤维化中的价值

龚尚红 曹雨石 郑小蝶 秦芳怡 杜晓晨 徐巧本

【摘要】 目的：观察血清瘦素（LP）及可溶性瘦素受体（SLP）在诊断非酒精性脂肪肝（NAFLD）合并肝纤维化中的价值。方法：选取2018年5月-2019年5月本院收治的72例NAFLD患者作为NAFLD组。同期选择35例本院门诊健康体检者作为对照组。根据非酒精性脂肪性肝纤维化评分（nonalcoholic fatty liver disease fibrosis score，NAFLDFS）将NAFLD组分为NAFLD无肝纤维化组（A组，NAFLDFS<-1.455，45例）与NAFLD伴肝纤维化组（B组，NAFLDFS≥-1.455，27例）。检测并比较各组血清LP、SLP、Ⅲ型前胶原（PCⅢ）、Ⅳ型胶原、层黏蛋白（LN）、透明质酸（HA）及血清空腹血糖（FBG）;计算并比较各组胰岛素抵抗指数（HOMA-IR）、NAFLDFS及BMI。分析上述血清学指标诊断NAFLD患者合并肝纤维化的价值。结果：NAFLD组血清PCⅢ、Ⅳ型胶原、LN、HA、FBG、LP水平及HOMA-IR、BMI均明显高于对照组，而血清SLP水平明顯低于对照组（P<0.05）;B组血清PCⅢ、Ⅳ型胶原、LN、HA、FBG、LP水平均明显高于A组，而血清SLP表达水平明显低于A组（P<0.05），两组HOMA-IR、BMI比较，差异均无统计学意义（P>0.05）;LP、SLP诊断NAFLD患者合并肝纤维化的AUC、敏感度及特异度均优于PCⅢ、Ⅳ型胶原、LN、HA、FBG。结论：血清LP及SLP在诊断NAFLD合并肝纤维化方面具有较好的临床价值。

【关键词】 瘦素 可溶性瘦素受体 非酒精性脂肪肝 肝纤维化

The Value of Serum LP and SLP in the Diagnosis of Non-alcoholic Fatty Liver Disease with Liver Fibrosis/GONG Shanghong， CAO Yushi， ZHENG Xiaodie， QIN Fangyi， DU Xiaochen， XU Qiaoben. //Medical Innovation of China， 2021， 18（13）： 0-064

[Abstract] Objective： To observe the value of serum LP and SLP in the diagnosis of non-alcoholic fatty liver disease （NAFLD） with liver fibrosis. Method： A total of 72 patients with NAFLD admitted to our hospital from May 2018 to May 2019 were selected as the NAFLD group. During the same period， 35 healthy subjects were selected as the control group. According to the nonalcoholic fatty liver disease fibrosis score （NAFLDFS）， the NAFLD group was divided into the NAFLD group without liver fibrosis （group A， NAFLDFS<-1.455， 45 cases） and NAFLD with liver fibrosis group （group B， NAFLDFS≥-1.455， 27 cases）. The levels of serum LP， SLP， PCⅢ， collagen type Ⅳ， LN， HA， FBG of all groups were detected and compared. The HOMA-IR， NAFLDFS， BMI of all groups were calculated and compared. The value of the above serological indexes in the diagnosis of liver fibrosis in NAFLD patients was analyzed. Result： The levels of serum PCⅢ， collagen type Ⅳ， LN， HA， FBG， LP and the HOMA-IR， BMI of the NAFLD group were significantly higher than those of the control group， while the level of serum SLP was significantly lower than that of control group （P<0.05）. The levels of serum PCⅢ， collagen type Ⅳ， LN， HA， FBG， LP of group B were significantly higher than those of group A， while the level of serum SLP was lower than that of group A （P<0.05）， and there were no significant differences in HOMA-IR and BMI between the two groups （P>0.05）. The AUC， sensitivity and specificity of LP， SLP in diagnosis of NAFLD with hepatic fibrosis were superior to PCⅢ， collagen type Ⅳ， LN， HA， FBG. Conclusion： Serum LP and SLP have good clinical value in the diagnosis of NAFLD with liver fibrosis.

[Key words] LP SLP Non-alcoholic fatty liver disease Liver fibrosis

First-authors address： Traditional Chinese Medicine Hospital of Songzi， Songzi 434200， China

doi：10.3969/j.issn.1674-4985.2021.13.015

近些年随着肥胖、糖尿病及代谢综合征在世界各国的广泛流行，非酒精性脂肪肝（non-alcoholic fatty liver disease，NAFLD）发病率及患病总人数明显升高，已成为导致慢性肝病发生的重要病因[1]。虽然多数NAFLD患者病情处于稳定状态，但流行病学调查显示仍有10%～20%患者可逐渐发展成为肝纤维化[2]。早期准确诊断NAFLD患者是否合并肝纤维化对于采取及时的治疗措施极为重要，但传统肝纤维化血清学指标检查结果易受某些因素影响而出现误差，故迫切需要寻找新的血清学检测指标[3]。有研究发现，瘦素（LP）及可溶性瘦素受体（SLP）在NAFLD发病过程中发挥着十分重要的作用[4]。故本研究拟观察血清LP及SLP在诊断NAFLD患者合并肝纤维化中的临床价值，现报道如下。

1 资料与方法

1.1 一般资料 选取2018年5月-2019年5月本院收治的72例NAFLD患者作为NAFLD组。同期选择35例本院门诊健康体检者作为对照组。纳入标准：NAFLD患者根据临床症状、肝脏超声影像学及实验室检查均符合相关诊断标准[5];所有患者及体检者年龄均大于18岁。……