非酒精性脂肪性肝病患者血清淀粉样蛋白A、血浆血红素氧合酶1和骨形成蛋白9水平变化及其临床意义探讨*

doi:10.3969/j.issn.1672-5069.2023.03.012

摘要/Abstract

摘要： 目的探讨非酒精性脂肪性肝病(NAFLD)患者血清淀粉样蛋白A(SAA)、血浆血红素氧合酶1(HO-1)和骨形成蛋白9(BMP-9)水平变化及其意义。方法 2018年7月～2022年3月我院诊治的87例NAFLD患者,行肝活检,根据病理学表现的不同将NAFLD组分为单纯性脂肪肝(SFL)28例、非酒精性脂肪性肝炎(NASH)48例和肝硬化11例,并根据病理学表现,将NASH分为早期10例和伴有肝纤维化的NASH 38例。另选择56例健康人作为对照。采用免疫比浊法检测血清SAA水平,采用双抗体夹心ELISA法检测血浆HO-1和BMP-9水平。结果 NAFLD组血清SAA和血浆HO-1水平分别为(8.2±1.5)mg/L和(14.9±2.3)ng/ml,显著高于健康人【分别为(3.3±0.6) mg/L和(10.1±2.1)ng/ml,P<0.05】,而血浆BMP-9水平为(95.1±6.1)pg/ml,显著低于健康人【(153.7±10.8)pg/ml,P<0.05】;肝硬化组血清SAA和血浆HO-1水平分别为(9.9±1.5)mg/L和(17.2±2.6)ng/ml,显著高于NASH组【分别为(8.3±1.1)mg/L和(15.2±2.4)ng/ml,P<0.05】或SFL组【分别为(7.5±0.9)mg/L和(13.7±2.1)ng/ml,P<0.05】,而血浆BMP-9水平为(81.8±6.9)pg/ml,显著低于NASH组【(93.6±7.3)pg/ml,P<0.05】或SFL组【(101.7±5.1)pg/ml,P<0.05】; 伴有肝纤维化的NASH组血清SAA和血浆HO-1水平分别为(9.0±1.8)mg/L和(16.4±2.5)ng/ml,显著高于早期NASH组【分别为(6.6±1.9)mg/L和(12.0±2.8)ng/ml,P<0.05】,而血浆BMP-9水平为(87.5±4.7)pg/ml,显著低于早期NASH组【(98.8±5.1)pg/ml,P<0.05】。结论 NAFLD患者血清SAA、血浆HO-1和BMP-9水平变化可能与肝组织脂肪变和纤维化程度有关,值得进一步研究。

关键词: 非酒精性脂肪性肝病, 血淀粉样蛋白A, 血红素氧合酶1, 骨形成蛋白9

Abstract: Objective The aim of this study was to explore the implications of serum amyloid A (SAA), plasma heme oxygenase-1 (HO-1) and bone morphogenetic protein 9 (BMP-9) level changes in patients with nonalcoholic fatty liver diseases (NAFLD). Methods 87 patients with NAFLD [simple fatty liver (SFL, n=28), nonalcoholic steatohepatitis (NASH, n=48) and liver cirrhosis (n=11)] and 56 healthy individuals were enrolled in our hospital between July 2018 and March 2022, and all patients with NAFLD underwent liver biopsies. The patients with NASH were divided histopathologically into early (n=10) and liver fibrosis stage (n=38). Serum SAA level was assayed by chemiluminescence immunoassay, and plasma HO-1 and BMP-9 levels were detected by double antibody sandwich ELISA. Results Serum SAA and plasma HO-1 levels in patients with NAFLD were (8.2±1.5)mg/L and (14.9±2.3)ng/ml, both significantly higher than [(3.3±0.6) mg/L and (10.1±2.1)ng/ml, respectively, P<0.05], while plasma BMP-9 level was (95.1±6.1)pg/ml, significantly lower than [(153.7±10.8)pg/ml, P<0.05] in healthy persons; serum SAA and plasma HO-1 levels in patients with NAFLD-related liver cirrhosis were (9.9±1.5)mg/L and (17.2±2.6)ng/ml, both much higher than [(8.3±1.1)mg/L and (15.2±2.4)ng/ml, respectively, P<0.05] in patients with NASH or [(7.5±0.9)mg/L and (13.7±2.1)ng/ml, respectively, P<0.05] in patients with SFL, while plasma BMP-9 level was (81.8±6.9)pg/ml, much lower than [(93.6±7.3)pg/ml, P<0.05] in patients with NASH or [(101.7±5.1)pg/ml, P<0.05] in patients with SFL; serum SAA and plasma HO-1 levels in patients with NASH-related fibrosis were (9.0±1.8)mg/L and (16.4±2.5)ng/ml, significantly higher than [(6.6±1.9)mg/L and (12.0±2.8)ng/ml, respectively, P<0.05], while plasma BMP-9 level was (87.5±4.7)pg/ml, significantly lower than [(98.8±5.1)pg/ml, P<0.05] in patients with early fibrosis. Conclusion The changes of serum SAA, and plasma HO-1 and BMP-9 levels in patients with NAFLD might be related to hepatic steatosis and fibrosis, which needs further investigation.

Key words: Nonalcoholic fatty liver diseases, Amyloid A, Heme oxygenase-1, Bone morphogenetic protein 9

湛栖睿, 段太美, 闫洁. 非酒精性脂肪性肝病患者血清淀粉样蛋白A、血浆血红素氧合酶1和骨形成蛋白9水平变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2023, 26(3): 348-351.

Zhan Qirui, Duan Taimei, Yan Jie. Changes of serum amyloid A, plasma heme oxygenase-1 and bone morphogenetic protein 9 levels in patients with nonalcoholic fatty liver diseases[J]. Journal of Practical Hepatology, 2023, 26(3): 348-351.

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非酒精性脂肪性肝病患者血清淀粉样蛋白A、血浆血红素氧合酶1和骨形成蛋白9水平变化及其临床意义探讨^*

Changes of serum amyloid A, plasma heme oxygenase-1 and bone morphogenetic protein 9 levels in patients with nonalcoholic fatty liver diseases

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