非酒精性脂肪性肝病患者血清胱抑素C、脂蛋白α和nesfatin-1水平变化及其临床意义探讨*

doi:10.3969/j.issn.1672-5069.2022.06.015

摘要/Abstract

摘要： 目的探讨非酒精性脂肪性肝病(NAFLD)患者血清胱抑素C(CysC)、脂蛋白α(Lp-α)和人新饱食分子蛋白1(nesfatin-1)水平变化及其临床意义。方法 2019年7月～2021年11月我院诊治的NAFLD患者119例和同期经年龄和性别匹配的健康体检者65例,采用ELISA法检测血清CysC、Lp-α和nesfatin-1水平,应用受试者工作特征曲线下面积(AUC)评估血清指标评估重度NAFLD的效能。结果 NAFLD患者血清CysC水平为(1.5±0.4)mg/L,显著高于对照组【(0.8±0.2)mg/L,P＜0.05】,而血清Lp-α和nesfatin-1水平分别为(88.5±18.6)mg/L和(0.9±0.2)ng/mL,显著低于对照组【分别为(140.3±29.5)mg/L和(1.6±0.3)ng/mL,P＜0.05】;重度NAFLD患者血清CysC水平为(1.9±0.3)mg/L,显著高于中度患者【(1.6±0.3)mg/L,P＜0.05】或轻度患者【(1.2±0.2)mg/L,P＜0.05】,而血清Lp-α和nesfatin-1水平分别为(63.6±15.9)mg/L和(0.4±0.1)ng/mL,显著低于中度患者【分别为(88.2±14.3)mg/L和(0.9±0.2)ng/mL,P＜0.05】或轻度患者【分别为(104.3±17.8)mg/L和(1.2±0.3)ng/mL,P＜0.05】;Logistic回归分析显示血清CysC、空腹血糖、甘油三酯、低密度脂蛋白胆固醇高水平或血清Lp-α和nesfatin-1低水平是严重NAFLD发生的独立危险因素(P＜0.05); 联合应用血清CysC、Lp-α和nesfatin-1水平评估重度NAFLD发生的AUC为0.887,显著高于三项指标单独评估的0.738、0.773和0.776(P＜0.05),其灵敏度、特异度和准确度分别为86.7%、80.9%和82.4%。结论 NAFLD患者血清CysC水平升高,而血清Lp-α和nesfatin-1水平降低,它们水平的变化与肝脂肪变程度相关,其临床意义值得探讨。

关键词: 非酒精性脂肪性肝病, 胱抑素C, 脂蛋白α, 人新饱食分子蛋白1

Abstract: Objective The aim of this study was to explore the changes of serum cystatin C (CysC), lipoprotein α (Lp-α) and human new satiety molecule protein 1 (nesfatin-1) levels in patients with non-alcoholic fatty liver diseases (NAFLD). Methods A total of 119 patients with NAFLD and 65 healthy individuals with matched age and gender were enrolled in our hospital between July 2019 and November 2021. Serum CysC, Lp-α and nesfatin-1 levels were detected by enzyme-linked immunosorbent assay. The area under the receiver operating characteristic curve (AUROC) was applied to evaluate the diagnostic efficacy of serum parameters. Results Serum CysC level in patients with NAFLD was (1.5±0.4)mg/L, much higher than [(0.8±0.2)mg/L, P＜0.05], while serum Lp-α and nesfatin-1 levels were (88.5±18.6)mg/L and (0.9±0.2)ng/mL, much lower than [(140.3±29.5)mg/L and (1.6±0.3)ng/mL, respectively, P＜0.05] in the healthy persons; serum CysC level in patients with severe fatty liver was (1.9±0.3)mg/L, much higher than [(1.6±0.3)mg/L, P＜0.05] in patients with moderate fatty liver or [(1.2±0.2)mg/L, P＜0.05] in patients with mild fatty liver, while serum Lp-α and nesfatin-1 levels were (63.6±15.9)mg/L and (0.4±0.1)ng/mL, significantly lower than [(88.2±14.3)mg/L and (0.9±0.2)ng/mL, P＜0.05] in patients with moderate fatty liver or [(104.3±17.8)mg/L and (1.2±0.3)ng/mL, P＜0.05] in patients with mild fatty liver; the Logistic regression analysis showed that increased serum CysC, fasting plasma glucose, TC and LDL-C levels or decreased serum Lp-α and nesfatin-1 levels were all the independent risk factors for severe fatty liver (P＜0.05); the AUROC was 0.887, with the sensitivity of 86.7%, the specificity of 80.9% and the accuracy of 82.4%, when the combination of the three serum parameters was applied in predicting severe fatty liver, much superior to 0.738, 0.773 and 0.776(P＜0.05) by any serum parameter alone. Conclusion Serum CysC level increases, while serum Lp-α and nesfatin-1 levels decrease in patients with NAFLD, which warrants further investigation for clinical application.

Key words: Non-alcoholic fatty liver diseases, Cystatin C, Lipoprotein α, Human new satiety molecule protein 1

樊叶, 张喜梅, 张岩. 非酒精性脂肪性肝病患者血清胱抑素C、脂蛋白α和nesfatin-1水平变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2022, 25(6): 816-819.

Fan Ye, Zhang Ximei, Zhang Yan. Clinical implication of serum cystatin C, lipoprotein α and nesfatin-1 levels in patients with non-alcoholic fatty liver diseases[J]. Journal of Practical Hepatology, 2022, 25(6): 816-819.

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非酒精性脂肪性肝病患者血清胱抑素C、脂蛋白α和nesfatin-1水平变化及其临床意义探讨^*

Clinical implication of serum cystatin C, lipoprotein α and nesfatin-1 levels in patients with non-alcoholic fatty liver diseases

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