NAFLD合并T2DM患者血清RBP-4、FGF21和NF-κB变化及其临床意义探讨*

doi:10.3969/j.issn.1672-5069.2026.01.014

摘要/Abstract

摘要： 目的探讨非酒精性脂肪性肝病(NAFLD)合并2型糖尿病(T2DM)患者血清视黄醇结合蛋白4(RBP-4)、成纤维细胞生长因子21(FGF21)和核因子κB(NF-κB)水平变化及其临床意义。方法 2022年7月～2025年7月我院诊治的257例NAFLD患者,其中合并T2DM患者132例。采用ELISA法检测血清RBP-4、FGF21和NF-κB水平,使用FibroTouch行肝脏硬度检测(LSM),并以此判断肝纤维化程度。应用多因素Logistic回归分析发生中重度肝纤维化的危险因素,绘制受试者工作特征曲线(ROC)并计算曲线下面积(AUC),评价血清指标预测肝纤维化的效能。结果 NAFLD合并T2DM患者血清RBP-4、FGF21和NF-κB水平分别为(15.3±2.7)ng/mL、(314.3±33.6)pg/mL和(4.1±0.5)pg/mL,均显著高于NAFLD患者【分别为(11.5±1.7)ng/mL、(277.8±31.8)pg/mL和(2.7±0.6)pg/mL,P<0.05】;39例中重度肝纤维化组血清总胆固醇、RBP-4、FGF21和NF-κB水平分别为(6.2±1.4)mmol/L、(17.7±2.0)ng/mL、(326.9±35.3)pg/mL和(4.2±0.5)pg/mL,均显著高于93例轻度肝纤维化组【分别为(5.7±1.3)mmol/L、(14.3±2.3)ng/mL、(309.0±31.6)pg/mL和(3.8±0.5)pg/mL,P<0.05】;多因素Logistic回归分析结果显示,血清RBP-4(OR=1.368)、FGF21(OR=1.252)和NF-κB(OR=2.563)高水平是NAFLD合并T2DM患者中重度肝纤维化的独立危险因素(P<0.05);ROC分析结果显示,血清RBP-4联合FGF21和NF-κB水平诊断NAFLD合并T2DM患者中重度肝纤维化的AUC为0.910,其敏感性为97.4%,特异性为72.0%。结论在NAFLD合并T2DM患者,检测血清RBP-4、FGF21和NF-κB水平可能帮助筛查肝纤维化的发生,指标高水平可能提示肝纤维化的存在。

关键词: 非酒精性脂肪性肝病, 2型糖尿病, 视黄醇结合蛋白4, 成纤维细胞生长因子21, 核因子κB, 肝纤维化, 诊断

Abstract: Objective The aim of this study was to investigate implication of serum retinol binding protein 4 (RBP-4), fibroblast growth factor 21 (FGF21) and nuclear factor kappa B (NF-κB) levels in patients with nonalcoholic fatty liver disease (NAFLD) and concomitant type 2 diabetes mellitus (T2DM). Methods 257 patients with NAFLD, of which NAFLD and T2DM concomitant in 132 cases, were enrolled in our hospital between July 2022 and July 2025, and all underwent Fibrotouch for liver stiffness measurement (LSM). Serum RBP-4, FGF21 and NF-κB levels were assayed by ELISA. Multivariate Logistic regression analysis was applied to find risk factors for liver fibrosis, and receiver operating characteristic (ROC) curve was drawn for evaluating diagnostic efficacy. Results Serum RBP-4, FGF21 and NF-κB levels in patients with NAFLD and T2DM were (15.3±2.7)ng/mL, (314.3±33.6)pg/mL and (4.1±0.5)pg/mL, all significantly higher than [(11.5±1.7)ng/mL, (277.8±31.8)pg/mL and (2.7±0.6)pg/mL, respectively P<0.05] in those with NAFLD; serum total cholesterol, RBP-4, FGF21 and NF-κB levels in 39 patients with moderate/severe liver fibrosis based on LSM were (6.2±1.4)mmol/L, (17.7±2.0)ng/mL, (326.9±35.3)pg/mL and (4.2±0.5)pg/mL, all significantly higher than [(5.7±1.3)mmol/L, (14.3±2.3)ng/mL, (309.0±31.6)pg/mL and (3.8±0.5)pg/mL, respectively, P<0.05] in 93 patients with mild liver fibrosis; multivariate Logistic regression analysis showed that elevated serum RBP-4(OR=1.368), FGF21(OR=1.252) and NF-κB (OR=2.563) levels were all the independent risk factors for liver fibrosis in patients with NAFLD and T2DM (P<0.05); ROC analysis demonstrated that the AUC was 0.910, with sensitivity of 97.4% and specificity of 72.0%, when serum RBP-4 level was combined with serum FGF21 and NF-κB levels in predicting moderate/severe liver fibrosis in patients with NAFLD and T2DM. Conclusion In patients with NAFLD and concomitant T2DM, increased serum RBP-4, FGF21 and NF-κB levels hint moderate-to-severe liver fibrosis existence, which might help clinicians screening liver fibrosis as early as possible.

Key words: Nonalcoholic fatty liver disease, Type 2 diabetes mellitus, Retinol binding protein 4, Fibroblast growth factor 21, Nuclear factor κB, Liver fibrosis, Diagnosis

施凌云, 吴彬彬, 史艳利. NAFLD合并T2DM患者血清RBP-4、FGF21和NF-κB变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2026, 29(1): 53-56.

Shi Lingyun, Wu Binbin, Shi Yanli. Implication of serum RBP-4, FGF21 and NF-κB levels in patients with NAFLD and concomitant T2DM[J]. Journal of Practical Hepatology, 2026, 29(1): 53-56.

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NAFLD合并T2DM患者血清RBP-4、FGF21和NF-κB变化及其临床意义探讨^*

Implication of serum RBP-4, FGF21 and NF-κB levels in patients with NAFLD and concomitant T2DM

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