非酒精性脂肪性肝炎患者血清成纤维细胞生长因子-21和脂联素水平变化及其临床意义探讨

doi:10.3969/j.issn.1672-5069.2020.05.014

摘要/Abstract

摘要： 目的探讨非酒精性脂肪性肝炎(NASH)患者血清成纤维细胞生长因子-21(FGF21)、脂联素(APN)和胰岛素抵抗水平变化及其临床意义。方法 2 018年7月～2019年8月我院就诊的41例NASH患者和41例同期健康人群,检测空腹血糖(FBG)和空腹胰岛素(FINS),计算稳态模型胰岛素抵抗(HOMA-IR)指数,采用ELISA法检测血清FGF21水平,采用放射免疫法检测血清APN水平。结果 NASH患者FBG水平为(8.7±1.6)mmol/L,显著高于健康人【(5.6±0.5)mmol/L,P<0.05】,FINS水平为(30.9±9.8)μIU/mL,显著高于健康人【(12.5±3.6)μIU/mL,P<0.05】,HOMA-IR水平为(1.9±1.1),显著低于健康人【(3.8±2.5),P<0.05】;NASH血清FGF21水平为(279.7±106.4)pg/mL,显著高于健康人【(141.2±62.5) pg/mL,P<0.05】,血清APN水平为(2.9±0.8)μg/mL,显著低于健康人【(4.1±1.0)μg/mL,P<0.05】;10例重度组患者血清FGF21水平为(285.7±116.4)pg/mL,显著高于16例中度组和15例轻度组【分别为(174.5±75.3)pg/mL和(150.7±65.5)pg/mL,P<0.05】,血清APN水平为(2.1±0.5)μg/mL,显著低于中度组和轻度组【分别为(2.6±0.9)μg/mL和(3.0±1.1)μg/mL,P<0.05】,FBG水平为(9.9±2.6)pg/mL,显著高于中度组和轻度组【分别为(7.5±2.1)pg/mL和(6.6±1.5)pg/mL,P<0.05】,FINS水平为(35.9±8.8)pg/mL,显著高于中度组和轻度组【(27.1±4.0)pg/mL和(15.5±3.6)pg/mL,P<0.05】,HOMA-IR水平为(1.5±1.0),显著低于中度组和轻度组【分别为(1.7±1.2)和(2.1±1.0),P<0.05】;17例存在高血压糖尿病或高脂血症的NASH患者血清FGF21水平为(315.7±99.2)pg/mL,显著高于24例无合并症组【(254.2±91.1)pg/mL, P<0.05】,血清APN水平为(2.6±0.7)μg/mL,显著低于无合并症组【(3.1±0.8)μg/mL,P<0.05】。结论合并有高血压、糖尿病和高脂血症的NASH患者血清FGF21水平升高,而血清APN和胰岛素抵抗指标降低,检测NASH患者血清FGF21、APN和胰岛素抵抗水平,有助于评估患者病情。

关键词: 非酒精性脂肪性肝炎, 成纤维细胞生长因子21, 脂联素, 胰岛素抵抗, 稳态模型胰岛素抵抗指数 , ,

Abstract: Objective The aim of this study was to investigate the changes of serum fibroblast growth factor-21 (FGF21) and adiponectin (APN) in patients with non-alcoholic steatohepatitis (NASH). Methods 41 patients with NASH and 41 healthy persons were recruited in our hospital between July 2018 and August 2019. The fasting blood glucose (FBG), fasting insulin (FINS) and homeostasis model insulin resistance (HOMA-IR) were obtained and serum FGF21 and APN levels were detected. Results The FBG level in patients with NASH was (8.7±1.6) mmol/L,significantly higher than in healthy persons, serum level of FINS was (30.9±9.8) μIU/mL, significantly higher than , the HOMA-IR was (1.9±1.1), significantly lower than that in healthy persons , serum FGF21 level in patients with NASH was (279.7±106.4) pg/mL, significantly higher than in healthy persons and serum APN level was (2.9±0.8) μg/mL, significantly lower than in healthy persons; serum FGF21 level in 10 patients with severe NASH was (285.7±116.4) pg/mL, significantly higher than in 16 patients with moderate NASH or in 15 patients with mild NASH, serum APN level in patients with severe NASH was (2.1±0.5) μg/mL, significantly lower than in patients with moderate or in patients with mild NASH, the FBG in patients in severe group was (9.9±2.6) pg/mL, significantly higher in moderate or in mild NASH, serum FINS level in patients in severe group was (35.9±8.8) pg/mL, significantly higher than in moderate or in mild NASH, and the HOMA in patients in the severe group was (1.5±1.0), significantly lower than in moderate group or in patients with mild NASH; serum FGF21 level in 17 NASH patients with high blood pressure, diabetes or/and hyperlipoidemia was (315.7±99.2) pg/mL, significantly higher than , serum APN level was (2.6±0.7) μg/mL , significantly lower than and the HOMA-IR was (1.6±0.9) ), significantly lower than in 24 patients without. Conclusion Serum FGF21 level is highly increased in NASH patients with hypertension, diabetes, and hyperlipoidemia, and serum APN level and insulin resistance decrease in patients with NASH. The detection of serum FGF21 and APN might help evaluate disease severity in patients with NASH in clinical practice.

Key words: Nonalcoholic steatohepatitis, Fibroblast growth factor 21, Adiponectin, Insulin resistance, Homeostasis model insulin resistance index

陈丽丽, 符茂雄, 刘正金, 方其超, 张茂. 非酒精性脂肪性肝炎患者血清成纤维细胞生长因子-21和脂联素水平变化及其临床意义探讨[J]. 实用肝脏病杂志, 2020, 23(5): 658-661.

Chen Lili, Fu Maoxiong, Liu Zhengjin, et al.. Changes of serum fibroblast growth factor 21 and adiponectin levels in patients with non-alcoholic steatohepatitis[J]. Journal of Practical Hepatology, 2020, 23(5): 658-661.

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