非酒精性脂肪性肝炎患者血清前神经降压素和微小RNA-122水平变化及其诊断脂肪性肝炎的价值探讨*

doi:10.3969/j.issn.1672-5069.2024.02.011

摘要/Abstract

摘要： 目的探讨非酒精性脂肪性肝病(NAFLD)患者血清脂肪细胞因子前神经降压素(Pro-NT)和微小RNA-122(miRNA-122)水平变化及其诊断非酒精性脂肪性肝炎(NASH)的潜在价值。方法 2017年1月～2022年6月我院诊治的NAFLD患者159例和同期入院体检的健康人90例, 行腹部超声检查, 采用ELISA法检测血清Pro-NT水平, 采用RT-PCR法检测血清miRNA-122。对NAFLD患者行肝活检检查, 确定NASH诊断。应用受试者工作特征曲线(ROC)并计算曲线下面积(AUC)评估指标诊断的敏感度和特异度。结果在159例NAFLD患者中, 经肝活检检查诊断NASH患者49例和单纯性脂肪肝110例;NASH患者BMI为(28.4±1.2)kg/m², 显著大于NAFLD患者【(27.3±1.4)kg/m², P<0.05】;NASH患者血清ALT、AST、空腹血糖(FBG)、胰岛素、HOMA-IR和尿酸水平分别为62(48, 96)U/L、56(47, 85)U/L、(5.9±0.6)mmol/L、10.2(8.8, 13.4)μU/mL、2.6(1.8, 3.4)和496(392, 515)μmol/L, 均显著高于NAFLD患者38(25, 53)U/L、32(21, 49)U/L、(5.3±0.6)mmol/L、9.0(7.2, 12.6)μU/mL、2.2(1.3, 2.7)和446(351, 495)μmol/L, P<0.05】;血清Pro-NT和miRNA-122分别为167(148.4, 186.9)pmol/L和8.2(2.0, 29.3), 显著高于NAFLD患者【分别为82(53.0, 100.4)pmol/L和2.2(1.4, 10.6), P<0.05】;NAFLD患者上述指标又显著高于健康人(P<0.05);分别以血清Pro-NT≥112 pmol/L和miRNA-122≥7.08为截断点, 结果Pro-NT诊断NASH的AUC为0.824, 灵敏度、特异度、阳性预测值和阴性预测值分别为80.0%、80.0%、84.9%和82.3%, 经Delong法检验, 显著优于miRNA-122诊断(分别为0.637、56.0%、70.0%、76.5%和56.8%, P<0.05)。结论应用血清Pro-NT水平在NAFLD患者中初筛NASH可能有一定的临床价值, 值得进一步研究。

关键词: 非酒精性脂肪性肝炎, 前神经降压素, 微小RNA-122, 诊断

Abstract: Objective The aim of this study was to explore the diagnostic performance of serum proneurotensin (Pro-NT), a adipose cytokine level and micro RNA (miRNA) load in patients with nonalcoholic steatohepatitis (NASH). Methods 159 patients with nonalcoholic fatty liver diseases (NAFLD) and 90 healthy persons were recruited in our hospital between January 2017 and June 2022, and the NAFLD was diagnosed by ultrasonography. Serum Pro-NT level was detected by ELISA, and serum miRNA load was assayed by RT-PCR. All patients with NAFLD received liver biopsies and the NASH was determined by histopathological examination. The area under the receiver operating characteristic curve (AUC) was applied to assess the diagnostic efficacy of serum parameters. Results Out of the 159 patients with NAFLD, the liver tissue examination found NASH in 49 cases (30.8%) and simple NAFLD in 110 cases (69.2%); the body mass index in patients with NASH was (28.4±1.2)kg/m², much greater than in patients with NAFLD; serum ALT, AST, fasting blood glucose, insulin, HOMA-IR and uric acid levels in patients with NASH were 62(48, 96)U/L, 56(47, 85)U/L, (5.9±0.6)mmol/L, 10.2(8.8, 13.4)μU/mL, 2.6(1.8, 3.4) and 496(392, 515)μmol/L, all significantly higher than 38(25, 53)U/L, 32(21, 49)U/L, (5.3±0.6)mmol/L, 9.0(7.2, 12.6)μU/mL, 2.2(1.3, 2.7) and 446(351, 495)μmol/L, respectively, P<0.05] in patients with NAFLD; serum Pro-NT level and miRNA-122 load were 167(148.4, 186.9)pmol/L and 8.2(2.0, 29.3), much higher than in patients with NAFLD; all the parameters in patients with NAFLD were much higher than in healthy persons (P<0.05); the diagnostic performance by serum Pro-NT level (≥112 pmol/L as the cut-off-value) was much superior to serum miRNA-122 (≥7.08 as the cut-off-value) by Delongin test in predicting the existence of NASH, with the AUC of 0.824, the sensitivity of 80.0%, the specificity of 80.0%, the positive predictive value of 84.9% and the negative predictive value of 82.3%, to 0.637, 56.0%, 70.0%, 76.5% and 56.8% (P<0.05) by serum miRNA-122. Conclusion Serum Pro-NT level might be acted as a non-invasive parameter for surveillance and screening of NASH in patients with NAFLD, and warrants further clinical investigation.

Key words: Nonalcoholic steatohepatitis, Proneurotensin, Micro RNA , Diagnosis

童静, 张珂瓈, 李昌平. 非酒精性脂肪性肝炎患者血清前神经降压素和微小RNA-122水平变化及其诊断脂肪性肝炎的价值探讨^*[J]. 实用肝脏病杂志, 2024, 27(2): 202-205.

Tong Jing, Zhang Keli, Li Changping. Diagnostic performance of serum proneurotensin level and micro RNA load in patients with nonalcoholic steatohepatitis[J]. Journal of Practical Hepatology, 2024, 27(2): 202-205.

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非酒精性脂肪性肝炎患者血清前神经降压素和微小RNA-122水平变化及其诊断脂肪性肝炎的价值探讨^*

Diagnostic performance of serum proneurotensin level and micro RNA load in patients with nonalcoholic steatohepatitis

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