非酒精性脂肪性肝病患者血清铁、铁蛋白轻链、不饱和铁结合力和转铁蛋白水平变化及其临床意义探讨*

doi:10.3969/j.issn.1672-5069.2025.04.018

摘要/Abstract

摘要： 目的检测非酒精性脂肪性肝病(NAFLD)患者铁代谢指标水平与病情严重程度的关系。方法 2022年1月～2024年3月仪征市人民医院收治的98例NAFLD患者和98例健康体检者,行腹部CT检查,应用Reformate软件检测并计算总脂肪面积(TAA)、总肌肉面积(SMA),肝/脾CT值比值(CT_L/S)和内脏脂肪体积/皮下脂肪体积(VAV/SAV)比值。采用ELISA法检测血清铁蛋白轻链(FTL),采用比色法检测血清铁(SI)和不饱和铁结合力(UIBC),采用比浊法检测转铁蛋白(TRF)。使用超声检查进行脂肪肝分度。结果超声诊断脂肪肝轻度、中度和重度分别为31例、33例和34例;中度脂肪肝组血清ALT、AST、TG和TC水平显著高于轻度组或健康人组(P<0.05),而重度组血清ALT、AST、TG和TC水平显著高于中度组(P<0.05);中度组血清SI、FTL和UIBC分别为(29.6±3.3)μmol/L、(439.5±15.6)μg/L和(73.1±5.7)μmol/L,均显著高于轻度组【分别为(20.9±3.9)μmol/L、(417.5±16.6)μg/L和(62.6±6.6)μmol/L,P<0.05】或健康人组【分别为(14.3±3.0)μmol/L、(303.6±18.5)μg/L和(50.5±7.5)μmol/L,P<0.05】,而TRF为(2.6±0.3)g/L,显著低于轻度组【(3.0±0.4)g/L,P<0.05】或健康人组【(3.5±0.6)g/L,P<0.05】;重度组血清SI、FTL和UIBC水平显著高于(P<0.05),而血清TRF水平显著低于中度组(P<0.05);中度组腹部CT检测的TAA、SMA和VAV/SAV比值显著大于(P<0.05),而CT_L/S显著低于轻度或健康人组(P<0.05);重度组TAA、SMA和VAV/SAV比值显著大于(P<0.05),而CT_L/S显著低于中度组(P<0.05)。结论 NAFLD患者血清铁代谢指标异常,可能与肝损伤程度相关,值得深入研究。

关键词: 非酒精性脂肪性肝病, 血清铁, 铁蛋白轻链, 不饱和铁结合力, 转铁蛋白

Abstract: Objective This study aimed to investigate iron metabolism index changes in patients with nonalcoholic fatty liver disease (NAFLD). Methods Ninety-eight patients with NAFLD and ninety-eight healthy individuals for physical examination were encountered in Yizheng People's Hospital between January 2022 to March 2024, and all underwent abdominal CT scan and total adipose area (TAA), total skeletal muscle area (SMA), liver-to-spleen CT value ratio (CT_L/S) and visceral adipose volume/subcutaneous adipose volume (VAV/SAV)ratio were measured and calculated by Reformate software. Serum ferritin light chain (FTL)was detected by ELISA, serum iron (SI)and unsaturated iron binding capacity (UIBC) were detected by colorimetry, and transferrin receptor (TRF) were assayed by turbidimetry. Fatty liver degree was determined by ultrasonography. Result Ultrasonography found mild, moderate and severe fatty liver in 31 cases, 33 cases and 34 cases in our series; serum ALT, AST, TG and TC levels in patients with moderate fatty liver were much higher than in those with mild fatty liver or healthy persons (P<0.05), and they were much higher in patients with severe fatty liver than in those with moderate (P<0.05);serumSI, FTLand UIBC levels in patients with moderate fatty liver were (29.6±3.3)μmol/L,(439.5±15.6)μg/L and (73.1±5.7)μmol/L, all much higher than [(20.9±3.9)μmol/L, (417.5±16.6)μg/Land (62.6±6.6)μmol/L, respectively, P<0.05] in patients with mild fatty liver or [(14.3±3.0)μmol/L, (303.6±18.5)μg/L and (50.5±7.5)μmol/L, respectively, P<0.05] in healthy persons, while serum TRF level was (2.6±0.3)g/L, much lower than [(3.0±0.4)g/L, P<0.05] in patients with mild fatty liver or [(3.5±0.6)g/L, P<0.05] in healthy individuals; TAA,SMA and VAV/SAV ratio in patients with moderate fatty liver were much greater (P<0.05), while CT_L/S was much less than in patients with mild fatty liver (P<0.05);TAA, SMA and VAV/SAV ratio in patients with severe fatty liver were much greater (P<0.05), while CT_L/S was much less than in patients with moderate fatty liver(P<0.05). Conclusion Iron metabolism is unstable in patients with NAFLD, which might be related to liver steatosis and inflammation and needs further investigation.

Key words: Non-alcoholic fatty liver disease, Serum iron, Ferritin light chain, Unsaturated iron binding capacity, Transferrin

王新田, 姚兰, 许珂, 韦颖. 非酒精性脂肪性肝病患者血清铁、铁蛋白轻链、不饱和铁结合力和转铁蛋白水平变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2025, 28(4): 549-552.

Wang Xintian, Yao Lan, Xu Ke, et al. Serum iron, ferritin light chain, unsaturated iron binding capacity and transferrin levels in patients with nonalcoholic fatty liver disease[J]. Journal of Practical Hepatology, 2025, 28(4): 549-552.

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非酒精性脂肪性肝病患者血清铁、铁蛋白轻链、不饱和铁结合力和转铁蛋白水平变化及其临床意义探讨^*

Serum iron, ferritin light chain, unsaturated iron binding capacity and transferrin levels in patients with nonalcoholic fatty liver disease

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