非酒精性脂肪性肝病合并T2DM患者血清成纤维细胞生长因子-21和分泌型卷曲相关蛋白5水平变化及其临床意义探讨*

doi:10.3969/j.issn.1672-5069.2024.03.010

摘要/Abstract

摘要： 目的探讨非酒精性脂肪性肝病(NAFLD)合并T2DM患者血清成纤维细胞生长因子-21(FGF21)和分泌型卷曲相关蛋白5(SFRP5)水平变化及其临床意义。方法 2020年5月～2023年3月我院诊治的NAFLD患者101例【单纯性脂肪肝(NAFL) 64例、非酒精性脂肪性肝炎(NASH) 25例和肝硬化(LC)12例】和NAFLD合并T2DM患者81例(NAFL 58例、NASH 16例和LC 7例),检测空腹血糖(FBG)、空腹胰岛素(FINS),计算胰岛素抵抗指数(HOMA-IR)。采用ELISA法检测血清FGF21和SFRP5水平。结果 NAFLD合并T2DM患者FBG、血清FINS、HOMA-IR和血清FGF21水平分别为(8.7±1.4)mmol/L、(28.9±5.8)μIU/mL、(11.1±2.7)和(304.8±36.0)pg/mL,均显著高于NAFLD患者【分别为(5.5±1.2)mmol/L、(20.8±4.1)μIU/mL、(5.1±1.5)和(267.6±34.5)pg/mL,P＜0.05】,而血清SFRP5水平为(6.8±1.2)pg/mL,显著低于NAFLD患者【(10.3±2.2)pg/mL,P＜0.05】;NAFLD合并T2DM患者血清TC、TG、HDL-C和LDL-C水平分别为(6.7±1.0)mmol/L、(3.7±0.6)mmol/L、(1.3±0.2)mmol/L和(3.4±0.8)mmol/L,与NAFLD患者【分别为(6.2±0.9)mmol/L、(4.1±0.5)mmol/L、(1.3±0.3)mmol/L和(3.2±0.7)mmol/L】比,差异无统计学意义(P>0.05);T2DM合并NAFL、合并NASH和合并肝硬化患者血清SFRP5水平分别为(7.8±1.1)pg/mL、(6.4±0.8)pg/mL和(5.1±0.7)pg/mL,显著低于NAFL、NASH和肝硬化患者【分别为(11.9±2.1)pg/mL、(9.8±1.6)pg/mL和(8.4±1.1)pg/mL,P＜0.05】,而血清FGF21水平分别为(295.6±31.2)pg/mL、(316.8±32.9)pg/mL和(353.6±36.7)pg/mL,显著高于NAFL、NASH和肝硬化患者【分别为(255.1±32.5)pg/mL、(279.5±33.4)pg/mL和(309.7±35.8)pg/mL,P＜0.05】。结论 NAFLD合并T2DM患者血清FGF21水平显著升高,而血清SFRP5水平显著降低,可应用于对病情严重程度的评估,值得深入研究。

关键词: 非酒精性脂肪性肝病, 2型糖尿病, 成纤维细胞生长因子-21, 分泌型卷曲相关蛋白5

Abstract: Objective The aim of this study was to explore the changes and clinical implications of serum fibroblast growth factor-21 (FGF21) and secreted frizzled related protein 5 (SFRP5) in patients with non-alcoholic fatty liver disease (NAFLD) and diabetes mellitus type 2(T2DM). Methods 101 patients with NAFLD, including nonalcoholic fatter liver(NAFL) in 64 cases, nonalcoholic steatohepatitis (NASH) in 25 cases and liver cirrhosis (LC) in 12 cases, and 81 patients with NAFLD and T2DM, including NAFL in 58 cases, NASH in 16 cases and LC in 7 cases, were enrolled in this study between May 2020 and March 2023, and the fasting blood glucose (FBG) and fasting insulin (FINS) levels were detected, and the homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Serum FGF21 and SFRP5 levels were detected by ELISA. Results The FBG, serum FINS, the HOMA-IR and serum FGF21 levels in patients with NAFLD and concomitant T2DM were (8.7±1.4)mmol/L, (28.9±5.8)μIU/mL, (11.1±2.7) and (304.8±36.0)pg/mL, all significantly higher than [(5.5±1.2)mmol/L,(20.8±4.1)μIU/mL, (5.1±1.5) and (267.6±34.5)pg/mL, respectively, P＜0.05], while serum SFRP5 level was (6.8±1.2)pg/mL, much lower than [(10.3±2.2)pg/mL, P＜0.05] in patients with NAFLD; serum total cholesterol, triglyceride,high-density lipoprotein cholesterol and low-density lipoprotein cholesterol levels in patients with NAFLD and T2DM were(6.7±1.0)mmol/L,(3.7±0.6)mmol/L,(1.3±0.2)mmol/L and (3.4±0.8)mmol/L, all not significantly different as compared to [(6.2±0.9)mmol/L, (4.1±0.5)mmol/L, (1.3±0.3)mmol/L and (3.2±0.7)mmol/L, respectively] in patients with NAFLD (P>0.05); serum SFRP5 levels in patients with T2DM and underlying NAFL, NASH and LC were (7.8±1.1)pg/mL, (6.4±0.8)pg/mL and (5.1±0.7)pg/mL, all significantly lower than [(11.9±2.1)pg/mL, (9.8±1.6)pg/mL and (8.4±1.1)pg/mL, respectively, P＜0.05], while serum FGF21 levels were (295.6±31.2)pg/mL, (316.8±32.9)pg/mL and (353.6±36.7)pg/mL, all significantly higher than [(255.1±32.5)pg/mL, (279.5±33.4)pg/mL and (309.7±35.8)pg/mL, respectively, P＜0.05] in patients with NAFL, with NASH or with LC. Conclusion Serum FGF21 level significantly increases, while serum SFRP5 level significantly decreases in patients with NAFLD and concomitant T2DM, which might be applied to predict the severity of the entity in clinical practice.

Key words: Non-alcoholic fatty liver diseases, Type 2 diabetes mellitus, Fibroblast growth factor-21, Secreted frizzled related protein 5

孙世磊, 刘翠翠, 李曙光, 鲁科翔. 非酒精性脂肪性肝病合并T2DM患者血清成纤维细胞生长因子-21和分泌型卷曲相关蛋白5水平变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2024, 27(3): 357-360.

Sun Shilei, Liu Cuicui, Li Shuguang, et al. Changes of serum fibroblast growth factor-21 and secreted frizzled related protein 5 in patients with non-alcoholic fatty liver disease and T2DM[J]. Journal of Practical Hepatology, 2024, 27(3): 357-360.

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非酒精性脂肪性肝病合并T2DM患者血清成纤维细胞生长因子-21和分泌型卷曲相关蛋白5水平变化及其临床意义探讨^*

Changes of serum fibroblast growth factor-21 and secreted frizzled related protein 5 in patients with non-alcoholic fatty liver disease and T2DM

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