非酒精性脂肪性肝病患者血清Arg-1水平和ApoB/ApoA1比值变化及其临床意义探讨*

doi:10.3969/j.issn.1672-5069.2025.01.014

摘要/Abstract

摘要： 目的探讨非酒精性脂肪性肝病(NAFLD)患者血清精氨酸酶-1(Arg-1)水平和载脂蛋白B/载脂蛋白A1(ApoB/ApoA1)比值的变化及其临床意义。方法 2021年2月～2023年12月江苏大学附属高淳医院诊治的69例NAFLD患者和50例健康人,NAFLD患者均接受肝活检,根据NAFLD 活动度积分(NAS)系统诊断非酒精性脂肪性肝炎(NASH)和肝纤维化,采用ELISA法检测血清Arg-1水平,采用免疫比浊法检测血清ApoB和ApoA1水平,计算ApoB/ApoA1比值。应用受试者工作特征曲线(ROC)并计算曲线下面积(AUC)评估诊断效能。结果在69例NAFLD患者中,肝组织学检查诊断单纯性脂肪肝(SFL)23例,NASH 32例(其中18例伴有肝纤维化)和脂肪性肝炎肝硬化14例;肝硬化组血清Arg-1水平和ApoB/ApoA1比值分别为(5.7±1.4)ng/ml和(1.0±0.2),均显著高于NASH组[分别为(4.6±1.2)ng/ml和(0.8±0.1),P<0.05]或SFL组[分别为(3.1±1.0)ng/ml和(0.7±0.1),P<0.05]或健康人组[(1.5±0.4)ng/ml和(0.5±0.1),P<0.05];伴有肝纤维化的NASH组血清Arg-1水平和ApoB/ApoA1比值分别为(5.5±1.2)ng/ml和(0.9±0.2),均显著高于NASH组[分别为(3.4±1.0)ng/ml和(0.7±0.1),P<0.05];联合血清Arg-1和ApoB/ApoA1比值诊断伴有肝纤维化的NASH的AUC为0.960(95%CI:0.893～1.000),其灵敏度和特异度分别为94.4%和92.9%,显著优于单个指标评估(P<0.05)。结论 NAFLD患者血清Arg-1水平和ApoB/ApoA1比值显著升高提示NASH的存在,并可能伴有肝纤维化,需要及时干预,值得临床深入研究。

关键词: 非酒精性脂肪性肝病, 非酒精性脂肪性肝炎, 肝纤维化, 精氨酸酶-1, 载脂蛋白B/载脂蛋白A1比值, 诊断

Abstract: Objective The aim of this study was to investigate changes of serum arginase-1 (Arg-1) levels and apolipoprotein B/apolipoprotein A1 ((ApoB/ApoA1) ratio in patients with non-alcoholic fatty liver disease (NAFLD). Methods 69 patients with NAFLD and 50 healthy volunteers were recruited in Gaochun Hospital, affiliated to Jiangsu University between February 2021 and December 2023, all patients with NAFLD underwent liver biopsies, and nonalcoholic steatohepatitis (NASH) and liver fibrosis were diagnosed based on NAFLD activity score (NAS). Serum Arg-1 levels were detected by ELISA, and serum ApoB/ApoA1 ratio was calculated. Receiver operating characteristic curve (ROC) was drawn and area under the curve (AUC) was obtained to predict NASH with liver fibrosis. Results Of 69 patients with NAFLD, liver histo-pathological examination showed simple fatty liver(SFL) in 23 cases, NASH in 32 cases [including significant liver fibrosis (SLF) in 18 cases] and NASH-related liver cirrhosis in 14 cases; serum Arg-1 level and ApoB/ApoA1 ratio in patients with liver cirrhosis were (5.7±1.4)ng/ml and (1.0±0.2), both significantly higher than [(4.6±1.2)ng/ml and (0.8±0.1), P<0.05] in patients with NASH or [(3.1±1.0)ng/ml and (0.7±0.1), P<0.05] in patients with SFL or [(1.5±0.4)ng/ml and (0.5±0.1), P<0.05] in healthy control; serum Arg-1 level and ApoB/ApoA1 ration in patients with NASH and SLF were (5.5±1.2)ng/ml and (0.9±0.2), both significantly higher than [(3.4±1.0)ng/ml and (0.7±0.1), respectively, P<0.05] in patients with NASH; ROC analysis showed that the AUC was 0.960(95%CI:0.893-1.000), with sensitivity of 94.4% and specificity of 92.9%, when serum Arg-1 levels and ApoB/ApoA1 ratio combination was applied to predict NASH with SLF, much superior to any parameters did alone (P<0.05). Conclusion Serum Arg-1 levels and ApoB/ApoA1 ratio significantly elevate, which might hint existence of NASH or even SLF, and need carefully concerned.

Key words: Non-alcoholic fatty liver disease, Nonalcoholic steatohepatitis, Liver fibrosis, Arginase-1, Apolipoprotein B/apolipoprotein A1 ratio, Diagnosis

马敏, 许巧云. 非酒精性脂肪性肝病患者血清Arg-1水平和ApoB/ApoA1比值变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2025, 28(1): 52-55.

Ma Min, Xu Qiaoyun. Clinical implications of serum arginase-1 levels and apolipoprotein B /apolipoprotein A1 ratio in patients with non-alcoholic fatty liver disease[J]. Journal of Practical Hepatology, 2025, 28(1): 52-55.

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非酒精性脂肪性肝病患者血清Arg-1水平和ApoB/ApoA1比值变化及其临床意义探讨^*

Clinical implications of serum arginase-1 levels and apolipoprotein B /apolipoprotein A1 ratio in patients with non-alcoholic fatty liver disease

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